Last Friday there was a “Steps to Adoption” work group that met in Sacramento to discuss and further refine the process for a RFA written report to be used in an adoption. There was too little information from that meeting to justify a newsletter, so instead, you are getting this email update.

There had been a series of adoption work group meetings prior to this meeting where CCOFFA had not been a participant. They had been working out quite a few of the details explaining the process of utilizing a RFA written report being used for adoption. CDSS shared a side-by-side chart (see attachment) showing how nearly everything required in adoption regulations is required in a RFA written report. There are additional items that will be added to the chart before official distribution. The two obvious difference are that adoption requires at least 3 visits and 3 references while RFA requires a minimum of 2 visits and 2 references. The bulk of the meeting involved discussion and feedback regarding a draft ACL explaining the RFA to adoption process. We will not share that draft at this time because it is so early in the process. The concern expressed by CCOFFA was that agencies are being required to do essentially an adoption quality written report without having the background and training to do so thoroughly. Concerns were expressed about a lack of information about life-long connections, adoption disruptions, and addressing infertility issues. These topics are typically address by adoption FFAs, but not likely broadly addressed by non-adoption FFAs.

CDSS stated that their role is to set standards, but not to determine best practice. CDSS shared a graph (see attachment) that illustrated how under the old system, there was limited information collected regarding a family, so when adoption became a possibility, there was a rush to get all the additional needed information (the orange line on the graph). With RFA, far more information is gathered initially and additional information is gathered as the family continues as a resource family. There may be cases where a county or a non-adoption FFA contacts an adoption FFA about the necessary work to complete an adoption. If the RFA written report is missing information or has not addressed issues of concern thoroughly, the adoption FFA cannot change the written report nor change an approval to a denial. This lead to a discussion of how the adoption FFA can gather the needed information and how that information can be documented and become part of the documentation for the resource family. It was suggested that the adoption FFA ask the FFA that originally produced the written report to gain the information desired so the original FFA can make any needed changes or additions to the written report they had created. Likewise, the adoption FFA would produce an Adoption Comparability Report that can address adoption specific issues or items not otherwise addressed. CDSS stated that they will likely create family evaluation trainings to help non-adoption FFAs create a more thorough written report. No date has been set on that at this time.

In the past, counties did adoptions basically as a favor to the State and had to do them according to the State mandates, including staffing and processes. With RFA, counties have the right to create the system that works for them within the RFA guidelines.

The adoption regulations will be updated. They were originally designed with the idea of independent adoptions rather than foster to adopt, so they need to be updated to match what adoptions look like now (85% of all adoptions in California are now through foster care).

There will be at least one more Steps to Adoption meeting, likely within 2 months. CCOFFA will update you following that meeting.

The following information was shared by CCL at this stakeholder meeting:

CCL’s purpose of this stakeholder’s meeting was to share their development of a new inspection process to better support agencies in prevention, enforcement, and compliance of CCL regulations and policies. There is an attachment to this newsletter, which was the hand-out at the meeting, and illustrates the changes CCL is beginning to create and implement. The process will be applied to all agencies and organizations that CCL oversees and they will be starting with adult and senior care. As they roll out the new process, they will be reviewing and analyzing how it is, and isn’t, working to create a process that supports CCL’s goals of prevention, enforcement, and compliance. The process and tools to support FFAs will be developed with the feedback and changes made as part of the adult and senior roll-out. CCL stressed that they fully understand the need for FFA homes considering CCR, RFA, and the goal of keeping youth out of long term congregate care. CCL knows that there are going to be capacity challenges and have no desire to close FFAs providing homes. CCL will be issuing Provider Information Notices (PINs) to keep FFAs informed.

CCL will be developing inspection tools, similar to the current CCL toolkits, so FFAs are fully informed of the expectations and will be able to self-assess their agencies to enhance compliance and limit the need for corrective actions. The inspection tool will be part of CCL’s Continuous Quality Improvement (CQI). As part of this process, CCL will be making the transparency website more user friendly and consistent throughout the state. To date, CCL has not had a tool for a comprehensive inspection and they are developing that tool now.

In the past, CCL’s role was heavily focused on enforcement. They want to support FFAs with additional prevention and compliance tools so that FFA’s don’t close and homes be lost. They want to work with FFAs to address issues and concerns before they become violations. There will be no new requirements in the inspection tool, but the focus will be on improving quality and pinpointing problems early on. CCL’s stated desire is that this inspection process be a collaborative effort with the FFAs and will be looking for input while they are rolling out and fine tuning the process. They want a more holistic viewpoint regarding the inspection process.

The inspection process for children’s residential care will focus primarily on resource families, STRTPs, and shelters. They will be piloting the inspection process with adults and seniors in the spring and the FFA inspection tools will be developed later in the year. The guiding principles are the protection of children and youth, collaboration and transparency with stakeholders, maintaining a deliberate and research based process, and to preserve capacity to serve children and youth.

The inspection will be based on domains (see page 3 of the Inspection Process Vision hand-out). The sample is for adult and senior care. Many, if not most, of the domains can be applied to children and youth in foster care, but further domains will need to be developed and CCL would like to get suggestions for domains from the FFAs. Each domain will have specific questions for the LPA, but the LPA will only ask questions from domains that are an area of concern.

There will be a total of five inspection tools: 1) pre-license inspection for new FFAs, STRTPs and shelters, which will include lots of physical plant items, 2) post licensing inspection, 3) a comprehensive inspection, 4) a standard inspection, and 5) a specialty inspection, which will focus on a single area of concern. Each of the inspections will have specific domains, as well as tools for the use of the providers.

Page 2 of the hand-out has the 4 phases of the development the inspection process. CCL wants all domains developed for children’s residential care to be with feedback from the stakeholders and providers. The goal is for the domains to be aligned with CCR mandated outcomes, including greater substantial compliance with a focus on the children and youth. CCL wants to know what areas would benefit from additional input, support, and attention.

There was a time at the end for comments and Q & A:

There was concern expressed that Prudent Parenting can be employed, and something negative can still happen. Those instances can reflect negatively on FFAs, even though no one did anything wrong.

There were concerns expressed that the behaviors of more challenging children and youth can reflect poorly on a FFA that serves more challenging youth.

CCL stated that they want to look at what’s happening, and what’s not, to help children’s/youth’s needs to be met.

The question was raised about how the FFAs will understand these changes. CCL replied that the will offer Quality Assurance trainings to their LPAs and will take a more relational approach with the providers. Information will also be shared in PINs and at the quarterly CCL/FFA meetings as time goes on.

There was a concern expressed that CCL ensures their expectations for providers will not conflict with accreditation requirements.

CCL would like the counties to be informed of this process the same time that providers are being informed and trained.

A question was asked about what technical support for this process would look like. CCL stated that the assistance could include referrals to experts to support a provider.

CCOFFA expressed concern that since CCL has been enforcement focused for so many years, this collaborative approach idea might be a hard thing to “sell” to the FFAs, especially to some of the smaller FFAs who fear CCR, accreditation, and RFA are intended to close FFAs.

CCL shared that this is not just a deficiency process, but a method to find and support best practice.

There was a suggestion made about creating a balance between capacity and quality, and a broader discussion was suggested.

Will Lightbourne, director of the California Department of Social Services, opened the meeting sharing that the first two years of the roll-out for CCR are seminal to its development and success. 200 FFAs have had their Program Statements reviewed and 61 potential STRTPs have been approved representing 1000 beds. The first phase of the new rates has been rolled out and the work on phase 2 is complete. CDSS is working on developing recruitment for homes willing to work with teens. CANS (child and adolescent needs and strengths) has been chosen as the state recommended assessment tool for youth in care. The critical items in process include the fact that non-STRTPs are “going to wind down.” CDSS is working with each county to find and plan for youth that will be leaving non-STRTPs. Some may go into transitional housing. The timeliness of RFA approvals are a challenge. There is lots of cross systems work trying to get this done. Counties are transitioning shelter care to temporary shelters. There is a strong focus on being flexible to be able to deal with unintended consequences.

Policy Development: Regarding temporary shelter care, the state has 9 transition plans that have been submitted. The state has bi-weekly calls with counties to assist them. There are now 18 licensed STRTP providers representing a total of 61 individual facilities. A number of STRTP applications are currently in review. ISFC (intensive services foster care) has been passed and developed. Regional Centers and counties have a workgroup with the goal of creating greater collaboration to discuss best practice and review service models. Policy is also doing SOGIE trainings and adding new staff.

Program and Services Implementation: The state has contracted with Denise Goodman, a nationally recognized expert in resource parent recruitment and retention. She is working with five pilot counties with the goal of finding families for specific children who have been hard to place. This process also taps into QPI (quality parenting initiative). The state is also utilizing Lightbox to research using all types of media, especially social media, for recruitment. This department will be focused on communication focused on meeting CCR goals, continuing education, and law enforcement. They are also looking at expanding the “ladder of engagement” to develop a greater support network for children and youth.

Foster Care Rates: The LOC protocol has been created and the Rates Bureau has been working on ACLs regarding the recent delayed implementation and there should be two more rate related ACLs released this month, including one about ISFC. There will also be an ACL focused on the Home-based Care rate protocol (including a matrix and scoring sheet), as well as an ACL about Special Care Increments (SCIs). The funding for SCIs was realigned in 2011, so there are no federal funds in SCI monies. CDSS is developing guidelines regarding SCI and the new rates. A Group Home extension is also being developed.

Resource Family Approval: They are looking at the RFA policies to see what may need to be changed, especially to speed up the approval process for kin and NREFMs. There will be new standards released in 2018. The RFA division is doing trainings for county social workers on psychosocial assessments and written reports. They are also working on a webinar that will be available on the RFA website regarding a number of specific topics. ACINs and ACLS are being developed to share this information. They are also working on an out-of-county approval protocol. They are also encouraging counties to encourage licensed foster families to do respite before the end of the year, which will qualify families who have not had placements in 2017 to be able to be RFA approved by the end of 2018 rather than the end of 2017. There will also be an ACIN about best practices for RFA.

Technical Assistance and Oversight: This is a new unit in the CCR division (that is connected to the county liaison unit) regarding RFA approval. They do monthly consultations with counties which include discussions about denials and due process. They also have quarterly meetings for supervisors and line staff, which can include a Q & A, guest speakers, input from Fire Marshals, and supplemental trainings. The RFA annual county review paperwork is being drafted for release in 2018. There are still six regional positions for this unit to be staffed.

CCL: CCL is involved with all parts of the CCR/RFA development. They are working with FFAs regarding the challenges being faced with caregiver background checks. CCL will be releasing a PIN that has an FAQ and addresses clearances, PRI numbers, and applicant types. They are also still working on Plans of Operation and Program Statement reviews. They are also offering technical assistance and guidance on revisions.

Education: CDSS provided a CCR training for the Department of Education and they are eager to be part of the CCR process. Schools are being encouraged to work with child welfare and the changes that are happening. Two of the foci are transportation and support services. The Department of Education is working on improved tracking for foster youth on their support and services dashboard. The dashboard includes a graphic representation of data all the way from a state-wide level to individual schools. This information can be linked to how money is being spent, including money spent on foster youth. This information could be used at CFTs. There is an education specific workgroup regarding CFTs. The workgroup developed an educational toolkit regarding CFTs. Questions can be emailed to rbernales@edu.ca.gov.

Performance and Transparency: They are focused on a provider performance dashboard and are deciding on what will be tracked regarding youth outcomes in 7 domains: safety, permanency, social connections, mental health, life skills, and consumer satisfaction. They want to solidify their data sources and review the information for value and accuracy. They hope to have the dashboard up and running by the fall of 2018. A youth satisfaction survey is being developed. California Youth Connection developed a 70-question survey that they believe a youth can fill out in about 5 minutes. This unit is also working with the foster youth ombudsman regarding distribution and collection of the surveys. This unit will be doing a quarterly report to the state legislature and will also do a quarterly county profile on youth in congregate care. Finally, they will also be asking for data from the counties about RFA applicants and approvals. There were a number of questions:

Will the dashboard indicators cover both FFAs and STRTPs? CDSS understands that there are some of the 7 domains over which a FFA or STRTP have little to no control. Some rubrics will be applied to both FFAs and STRTPs. Counties will similarly be reviewed by CDSS. The dashboard will include context to support accurate interpretation. The dashboard will be public, but CDSS has not yet decided where the information will be stored.

Will Lightbox be just for the counties, or will FFAs be able to benefit from it as well? The intent is that FFAs will be able to benefit as well; however, for the pilot, it’s counties only. Effective methods of social media will be shared. The five pilot counties are Sacramento, San Joaquin, Riverside, Sonoma, and Kings.

Mental Health: AB 1299 focuses on presumptive transfer so youth will receive needed mental health services wherever they reside. DHCS (the Department of Health Care Services) is in the process of drafting information notices to help with implementation, including procedures, steps and responsibilities. No specifics were shared. The RITE (Regional Ideas & Transformation Exchange) meetings have had a lot of questions about Mental Health issues and their upcoming information notice should help. DHCS is working with judicial counsel regarding the role of the courts regarding the determinations for presumptive transfer. They are also focused on STRTP program approval. DHCS has received a lot of feedback and they are reviewing it all. The Medi-cal Manual is being updated regarding TFC services and specifics of what is needed for families and agencies to provide TFC services. A draft of the updated manual was released for review and changes are being made based on the feedback. There will not be a lot of policy changes, but the format is going to be changed significantly to make it more user friendly. There are changes regarding STRTPS in the manual. They expect to release am information letter in December. DHCS is working with stakeholders at all levels to develop a TFC resource tool kit, including training topics and resources. As shared above, CANS was CDSS’ preference for an assessment toll and, independently, DGCS has also chosen CANS, so the departments will be working together on how the CFSS and DHCS elements will coordinate. A schedule for those meetings has not yet been set.

There were some questions from the attendees:

What about making sure Mental Health Professionals are adoption competent? NTI (National Training Initiative) has been doing a pilot training on adoption competency with counties and agencies and a Mental Health adoption competency training pilot will be offered in March of 2018.

Some counties have turned down group homes’ request for a letter of support to become a STRTP. If the county won’t approve, the county Mental Health won’t approve. Is there a plan to deal with that? If a group home cannot get support from their county of residence, they can seek if from a county with whom they have a strong relationship. There does need to be a conversation about why a group home isn’t getting support from their county of residence. If a group home or FFA is having trouble with support, they can reach out to CDSS for help and a possible support letter. It will be viewed on a provider-by-provider situation. The next problem is if an out-of-county Mental Health provider does not want to offer services out-of-county. DHCS can do a plan approval even if a county Mental Health provider won’t look at it. A MOU can be used to reach a consensus.

A Sacramento ICWA agency is having a hard time meeting with Sacramento County to discuss them creating a STRTP and FFA. CDSS stated that they will help.

There was a statement from an STRTP about Mental Health contracts and methadone administration. There was no immediate answer, although the state could okay that as well.

A FFA was recently told that CCL cannot approve their addendums because those addendums fell under the jurisdiction of the Rates Bureau. CCL confirmed that is true for rate related items.

For an FFA that wants to offer ISFC, what are the process, resources, and capacity requirements? Under ITFC, it was about the agency’s program, with ISFC, it’s about the child’s/youth’s needs. It is a rate-centered process.

Are there any concerns about the new rates that are effective 12/1/17 where resource parents will be getting a lower reimbursement for working with teens who are at a low LOC? CDSS stressed that resource parents with teens currently in placement will continue to receive their old rate as long as the youth remains in the home and are not assigned a new Level of Care. CDSS acknowledged that for teens now being placed, the low LOC rate is lower than the old age-based rate. Regarding questions about LOCs, email LOC@dss.ca.gov

Will the state advise the counties of how long they have to determine a child’s/youth’s LOC? They have 60 days with the payments being retroactive to the date of placement. They are hoping that with a CANS assessment, it will take less than 60 days.

Will a child/youth going into respite trigger a LOC review? No.

ACIN 1-15-17 has gone out regarding Group Home Extension.

Where is information about the Service and Support Rate? It is still in development and review.

Does the Medi-cal manual have guidelines or example for parents about how to properly document and take notes? Yes.

Is TFC a duplication of other Mental Health services? Is that addressed in the manual? There are some lock-outs for specific situations. TFC parents can only provide TFC services, but that cannot be the only services a child/youth is receiving; there must be Mental Health oversight.

CANS/CFT Implementation: As noted above, CANS was the assessment choice of both CDSS and DHCS. They had pilot where some counties tried CANS and some tried TOP (Treatment Outcome Package). CDSS had a third-party evaluator analyze the results and feedback to see if either would work as a broad-based objective assessment. TOP allowed for child and family input, but there were challenges with participation. One desire is that the assessment tool would be embedded in the CFT process. The new CWS/CMS digital tool is better for data analysis. It is very helpful when youth are served by both CDSS and DHCS. There is a joint CDSS/DHCS letter being developed regarding CANS and that the information from the CANS will be shared in the CFT. CANS be updated as the child/youth ages. This letter will address the implementation of CANS as the state preferred assessment tool. FYI, probation has its own assessment tool that is more effective for their youth they serve and they will continue to use that assessment tool. Regarding CFTs – a team approach is not new per se. There are CDSS and DHCS staff focusing on CFTs in light of CANS. They received feedback from the field that family, friends, or providers had been left out of the CFT. CDSS’ goal is to create a model for a CFT facilitator who will be responsible to do the CANS. They are to ensure that the CANS is completed in a timely manner as part of the CFT process, so it can inform the final case plan. Policy and tools are currently being developed regarding the facilitator and the CFT. The CANS is to be viewed as a process rather than an event. CDSS is working on a Request for Information (RFI) on who could fill the role of a CFT facilitator. The goal is to build a state-wide pool of providers for CFT/CANS. Questions from attendees included:

Has the model for implementation been developed yet? The goal is to NOT have duplicative CANS assessment for the same child/youth. The first CANS will become the CANS used for the CFT. CDSS will not create a hardcore blueprint for CFTs, but will take input from multiple services to develop standards and guidelines. Facilitators do not have to be county staff. Who will the facilitators will be will likely be determined by the counties.

If a child does not receive Mental Health services, will the FFA administer the CANS? It needs to be done by the CFT facilitator. Case carrying social worker will not be the facilitator for a child on their caseload. This idea supports the Integrated Core Practice Model.

Is this policy a mandate? Will a facilitator be required? Yes. And there is funding for CFTs.

The question was for both CDSS and DHCS – how will a release of information be handled for the information from the CANS and in a CFT? Both sides are currently developing the needed forms and sharing information is an expectation. A joint letter will be coming out in the next couple of weeks and the policy will come out in the next couple of months.

Does CANS and Katie A screening work together? The counties will determine what the procedures will be. Some counties are having the CANS replace the Katie A screening.

There was a request for examples of how early implementing counties are doing it to create greater clarity about the evolution and process. This is especially true regarding Mental Health related assessments.

There was a suggestion to use the term behavioral health rather than mental health.

Are educational requirements being ironed out for the CFT? Not yet.

Richard Knecht then shared a Power Point presentation, “Four Anchor Documents to Sustainable Implementation of Systems of Care in California.” His Power Point, along with all other hand-outs for this meeting will be forwarded in another email. The attachments are very large and your ISP may not accept them. If you have a gmail account, I can share the documents as a google doc if you will email me from your gmail email account requesting access to the documents. Please review his Power Point for details. The attendees then broke into three groups – each group reviewing one of three of the anchor documents. The three documents are included in the forwarded email. Below is a brief summary of the feedback from each of the three groups.

California’s Integrated Training Guide. This document focuses on cross system training and practice. The attendees like that the birth family and youth are included in these trainings. They did have concerns about information sharing. At this time, county training is not being offered to providers.

MOU. CDSS shared a master MOU template that counties can use to define and refine working relationships with providers. The attendees liked a lot about the MOU and its focus on data management and information sharing.

The California Integrated Core Practice Model (ICPM) ICPM is a major shift because it includes the birth family and child/youth as a primary partner in their success, rather than them being seen as the problem. The attendees liked the shift of mindset. There were concerns that old-school social worker may not be able to make the shift and birth families may have a hard time believing that this change of attitude and approach is genuine and real. There were approximately 25 attendees in this breakout group representing a number of different providers and entities. None had seen this document before or had been asked to be part of its development. From the language, it was likely that neither CYC or the SOGIE workgroup had been part of the development either. For a focus on integration, its development had not been very integrated. However, again, it is a needed shift in approach.

UPDATE ON THE SIGN-UPS FOR NTI (The National Adoption Competency Mental Health Training Initiative)

As we had shared in earlier newsletters, California was one of 7 states approached to be part of a pilot online 24 hour adoption competency training (with free CEUs). We had to come up with at least 200 participants in order for California to be in the pilot. So far, we have had over 2500 applicants, so NTI in California is a go! There will be a webinar regarding NTI on April 13 and all applicants will be sent the information regarding the webinar soon. There will be a Mental Health version of the NTI training released for pilot in 2018, and NTI will launch nationally in 2019. NTI will still accept letters of interest up until the April 13 webinar. If you are interested and have not yet signed up, you can email CFSNTI@dss.ca.gov and the application can be found at the end of the ACIN 1-01-17, http://www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acin/2017/I-01_17.pdf

Policy Development: Every problems being worked on in CCR is multi-level one and needs a team approach in order to succeed. Almost 200 of the 203 distinct FFAs have submitted their revised Plan of Operation and Program Statements. More are needed from the group homes. For FFAs, CDSS is not yet being strict with the Mental Health provisions because they are still being worked out at the State level. However, in order to be a STRTP, they have to have a clearly laid out Mental Health services component. CDSS review of the STRTP Program Statements are focusing on the Mental Health and transitions elements. CDSS is planning to have LOTS of technical support to help FFAs and STRTPs in this CCR/RFA transition and they will even offer support regarding specific placed children/youth. CDSS is committed to make CCR and RFA work and will function with that goal in mind. This includes fine-tuning and participation in MOUs at multiple levels and they are creating model MOUs that can be used. They are also working closely with both Mental Health and Education.

CDSS is working on Interim Licensing Standards for “under 6”, minor parents, and temporary shelter care. They are currently reviewing the standards for temporary shelter care and that is almost done. There have been 30-day shelter care centers, but CDSS is shutting those down in favor of 10-day shelter care. There are also contracted shelter care facilities, but those would need to qualify as STRTPs and children/youth placed there would need to qualify for STRTP placement. CDSS is also examining the possibility of emergency shelter homes. The question was asked how many counties have contracted with group homes as emergency shelters and three counties have done that in the past. CDSS is looking for viable options for shelter care that fits with the requirements and limitations of CCR/RFA. There was a request for CDSS to share some of the best practices that are working throughout the state. There is a lot of concern about shutting down the current emergency shelter situations throughout the state without having viable alternatives in place. Capacity is likely to be a significant challenge. Some counties expressed concern because they had used home based shelter care in the past and replaced that with non-home based shelters, which they felt was a better option. Now they are being told to go back to the system they chose to replace.

Foster Care Rates: Cheryl Treadwell of Rate Setting shared that there was a 1/17 ACL: http://www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acl/2017/17-11.pdf that discussed Phase 1 of the new rate structure, with Phase 2 going into effect on 12/1/17. The delay on the roll-out was due to the fact that they are still fine tuning the definitions of each of the Levels of Care, and that the State automation had to be brought up-to-speed to process the payment information related to the levels of care. They feel that they have finalized the strength-based protocols for the LOCs based on care and supervision needs. She shared there will be a 3/30/17 webinar from UC Davis on the Levels of Care and it will be available for viewing after that date. They will run pilots of the LOC in May and June in select counties to find out what needs to be adjusted. Cheryl shared that there is a matrix of “triggering events” that will help to determine the appropriate Level of Care. CDSS also recently had a meeting with counties and select providers to determine the parameters for a child/youth being in a ITFC placement, which is important for children/youth stepping down from congregate care. There are some of these elements which will need to be put into statute (law). Cheryl is open to input from providers who currently do ITFC work – email Cheryl Treadwell at: Cheryl.Treadwell@dss.ca.gov The question was asked if counties can pay FFAs a higher rate for ITFC until the LOC is in place; the answer was yes. There are anticipated increases in the wrap-around rates to the STRTP rate. It was shared that STRTPs would be getting just over $12,000 per placement, but would be providing over $14,000 in services. It was stated that the difference should be made up in medi-cal payments received for specialty Mental Health services through EPSDT funds. For further details regarding CCR’s impact on groups homes, contact California Alliance at http://www.cacfs.org/. STRTPs were encouraged to check out the Medi-cal Billing Documentation Guide at the CDSS website: https://files.medi-cal.ca.gov/pubsdoco/manuals_menu.asp CDSS is also offering Medi-cal 101 classes throughout the state (sorry, CCOFFA does not have that calendar).

Resource Family Approval: CDSS distributed copies of PIN 17-03-CRP (see attached) that explains how to transition current certified foster parents into approved resource parents. With 200 revised Program Statements having been submitted, CDSS is first looking at the RFA elements and letting he FFA know if changes needs to be made. Once the RFA portion is in good working order, then CDSS will review the balance of the revised Plan of Operation and Program Statement. CDSS stressed that they do not want this document to be a one-and-done, don’t-look-at-it-again dusty document, but rather a living document that can be continuously improved and enhanced. With conversion, there are 3 levels of approval: 1) families that are already adoption printed and approved simply need to submit the new RFA documents; 2) non-adoptive certified foster parents who have children in placement at some point during 2017 need a psychosocial assessment completed, background checks, and RFA (and CACI) fingerprint clearances done; 3) non-adoptive certified foster parents who have not had a placement at any time in 2017 will need to be converted to RFA by no later than 12/31/17 or their certification will be terminated on 1/1/18. You can get additional RFA information at http://calswec.berkeley.edu/toolkits/resource-family-approval-rfa There was a question about when FFAs will hear about their submitted revised Program Statements and it was shared that all FFAs should hear back within the next few days.

Program and Services Implementation: An ACL has been drafted outlining the change from respite being only 72 hours at a time to 14 days in a month. CDSS understands there are challenges to new families and a longer respite break may help with retention. CDSS is discussing possible options for people providing respite so they will not need to be RFA approved. There is another ACL being created by CDSS in conjunction with the Interagency Placement Committee regarding the requirements for a child/youth to go into a STRTP placement. That draft ACL will go out soon for review. CDSS has hired consultants that work with non-profits and philanthropic organizations for developing creative solutions. Specifically for CDSS, it is for resource parent recruitment and retention, and to be able to build capacity. They have been researching how to re-brand foster children, foster care, the role of foster parents, the birth parents, and are figuring out the target groups. They would like to get people involved first in more of a support role, mentoring or volunteering, to expose them to aspect of foster care with the goal of creating a buy-in. They will be interviewing foster parents and will host an online forum regarding adoption, with a focus on older children/youth, probation youth, and CSEC. They hope to video the interviews o share and pilot their ideas in five counties. They are also contracting with Denise Goodman (see an example of her advice): http://centervideo.forest.usf.edu/qpi/targrecrustrat/handout05.pdf Denise is an expert on foster parent recruitment and retention, who has also worked to increase the number of children going into home-based care from congregate care. She will do some regional convenings where she will train attendees in her methods. She will also be working with specific counties and will be available for consultation. The question was asked if STRTPs can take a mix of 300s, 600s, and private placements; a ACL will be coming out that answers that question.

Education: The San Mateo Multidisciplinary Model has worked to coordinate the efforts of Mental Health, Child Welfare, and Education. They have created an array of services that helps children/youth, regardless of how they youth entered the system. The service is crisis focused and offers wrap-around services, be it through special education or child welfare. They are examining the types of services, support, and linkages to eliminate barriers for service. State Education is developing a common confidentiality agreement, since every department and division throughout the state tends to have their own. “Everyone knows the why and the what. The counties want to know the how” of helping children/youth access needed services. They stressed that each element state-wide needs to hear it from their own leadership.

Counties are to look at the FFA and STRTP Program Statements that have been submitted to them to ensure the agencies are in alignment with the county and their implementation of CCR and RFA.

There was a question about counties being notified when a child/youth from another county has been placed with a resource home or STRTP in their county. This is very important now that, according to AB1299, the county where a child/youth is placed is expected to provide services to that child. There is currently no notification system in place and digitally based solutions are being sought. This is an issue for schools as well.

There was a concern where STRTPs may have children/youth from multiple counties and each may have its own, different requirements for CFTs.

Proposed framework for evaluating the performance of FFAs and STRTPs: The attendees were broken into four work groups to review and make recommendations regarding the CCR Outcomes and Performance Measures (see attached initial draft). This draft had been developed by a team earlier and was shared with attendees for feedback and suggestions. The work groups had just under two hours for the task, and none got all the way through the 8 domains in the document. The feedback included:

Why is this just regarding FFAs and STRTPs when the changes are supposed to be system wide – including counties home and kin placements. CDSS shared that CCR required that FFAs and STRTPs would be looked at first.

This document will not work well for STRTPs that serve a very targeted population. Such as, law enforcement involvement is a negative, but what about STRTPs that only work with challenging probation youth. It was requested that the law enforcement involvement be split into two categories: AWOL and non-AWOL law enforcement involvement.

There are lots of terms that were too vague (e.g. “regular connections with community of origin” or “timely assessments of behavioral health needs”)

There are items that cannot be truly measured (e.g. exhibiting positive self-esteem or healthy sexuality, or “% of resource parents who act according to Prudent Parenting Standards”).

There are a number of the items that are already being well tracked by existing tracking tools.

Each work group summarized their findings and submitted them. They will be reviewed by the Executive Committee on March 28.

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ONE LAST PUSH FOR THE NTI ADOPTION COMPETENCY TRAINING plus INFORMATION FROM THE Last (for now) CCR PROBATION WORK GROUP 2/15/17

FRIDAY, FEBRUARY 17 IS THE LAST DAY TO SIGN UP FOR NTI (The National Adoption Competency Mental Health Training Initiative)

Friday is the deadline for this opportunity for 24 hours of FREE online adoption competency training (with 24 FREE hours of CEUs). This is an amazing opportunity for every FFA to gain quality adoption competency training that includes trauma training. California is one of 8 states in the pilot roll out of the NTI training. The “price” an FFA pays is a commitment to complete the training and provide feedback. This has valuable information that would benefit every FFA’s social work staff and their supervisors. Obviously CCOFFA is sold on this training and we feel it would benefit each and every FFA in California to sign up by Friday. You can email Theresa Thurmond at theresa.thurmond@dss.ca.gov and the application can be found at the end of the ACIN 1-01-17, http://www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acin/2017/I-01_17.pdf

CCR PROBATION WORK GROUP INFORMATION

This probation work group meeting was the last of a series and was intended to finish addressing all the issues relating to CCR and probation youth. Following are the highlights from the meeting:

General recruitment and retention strategies

Data and probation outreach results:

CDSS shared data (see email newsletter attachment power point slides, pages 6 and 7) about how many youths in probation are in kin and FFA placements rather than congregate care. The State believes that at least half of the youth in lower level group homes (RCL 10 and 11) won’t qualify for STRTP placement and would do fine in FFA family placements. With the change to RFA, because all kin placement homes will need to be RFA approved, some of the kin adults with criminal histories will not meet RFA approval standards. Therefore, there will likely be an increased need for FFA homes. There was some discussion from county probation representatives (especially LA county) about the accuracy of the figures in the chart. There are youth in level 12 homes that are not level 12 kids – it was just the only group home bed available, so FFAs should not be intimidated with a referral of a youth out of a level 12 home. It was suggested that they look at the youth’s history and file to see what behaviors and needs they truly have.

CDSS representatives talked with some FFAs that work with probation youth to see what works for them. They said what helps the most is having a good working relationship with the Probation Department. It really helps when Probation helps train the resource parents on how to work with their youth. WRAP services are also very helpful. What isn’t working is the lack of homes for teens and youth on probation and the fact they have increased service needs, but no rate increase. It also helps to have the youth’s birth family involved and providing grief support and ILSP focused workshops. They have found that using Motivational Interviewing and trauma-informed methods are also beneficial. One FFA is using the Treatment Foster Care of Oregon model: http://www.tfcoregon.com/ For recruitment, they have sought out empty nesters and have sent out mailers targeting the LGBT and Hispanic communities. They have reached out to the faith-based communities, but those outreaches have not been very successful. Many counties are talking with the youth in probation to see with whom they are already connected and recruiting in those settings.

A State representative also discussed how they are working on a criminal clearance evaluator manual that is county-specific. They are working with CACI (Child Abuse Central Index) and CBCB (Caregiver Background Check Bureau) in developing this. They are also working on a “simplified clearance” where if an applicant has a non-violent offense that is over 5 years in the past, they can be cleared quickly. They are also proposing a simple clearance for those with two non-violent offenses that are more than 15 years old. They hope to have the draft complete in the next few weeks. Probation has some frustrations about getting access to ORI numbers. Similar to non-adoption FFAs, they are simply informed there is “a hit” without knowing what the offense is. They are also working on making transfer of fingerprint clearances easier between entities of the same type (FFA to FFA, group home staff to another group home).

Foster Parent Recruitment, Retention, and Support (FPRRS)

(please see the FPRRS hand out) The State has given the counties millions of dollars to support foster parent recruitment and retention. A number of representatives shared how FPRRS money is being used, including caregiver support (that can include buying furniture, smoke alarms, car seats, etc.) and even buying a youth a bike so they could get to school and work. Generally speaking, the counties are using FPRRS money for a number of one time, pragmatic supports enabling a family to take in a child/youth and sustain the placement. They have used FPRRS money for bill board ads and one county used the funds to open a 24-hour crisis line. There will be a report coming out that goes into specifics of how the money was utilized in the various categories listed in the hand-out. Ventura County Probation has used the funds to hire a Senior Probation Office working on CCR, CFTs and accessing WRAP services and have hired a transportation worker as well. They also use the funds to support youth by buying team uniforms, sports league membership fees, and other practical needs. Monterey County has been using the funds to contract with local FFAs to provide services. They would like to use some of the funds to facilitate better birth family finding efforts, but there are no software programs that do that. They are currently relying on schools, CASA, and searching social media to find a youth’s relatives. It is their desire to contract with an FFA to provide a family finder who would work out of the Probation office. Los Angeles County will be having a meeting next week to discuss how best to utilize FPRRS funding. There is a challenge because a lot of the relative placements are not RFA placements, so the families do not have access to funding, training, or support.

Gail Johnson-Vaughn of Families Now shared how there needs to be a fundamental shift away from the ideas that youth from probation are unadoptable and that no one wants them. She stressed the need for probation to shift to a mindset of seeking permanency for youth if they are not returning to birth family. She shared that there 5 keys to permanency: 1) Believe it is possible, 2) Create a culture of permanency, 3) Address the youth’s history of trauma, separation, and loss, 4) Provide specialized permanency services, and 5) Follow the law. She shared that rather than doing a broad-based “we need foster and adoption parents” approach, that you market each child to find a family for them. An example was a youth form probation that had no family to go back to, but wanted to become a farmer, so information about him was shared in farming communities and he found an adoptive home. She encouraged use of Darla Henry’s 3-5-7 model (http://darlahenry.org/the-3-5-7-model/)

She talked about sharing about the youth through adoption exchanges and the Heart Galleries. LA County has the motto “Do whatever it takes” and Gail Johnson-Vaughn echoed that sentiment. (see attached “Advocating Permanency for Crossover Youth”)

Building Capacity

There was a panel discussion with a representative from the Seneca Family of Agencies, Marin County and Alameda County. Seneca and Marin County have piloted M.Y. (Marin Youth) House (see hand-out for details). They have two homes in Marin that can each serve two youth and functions as an ITFC (Intensive Treatment Foster Care) home. The goal is for the youth from probation to be there no longer than six months before a move towards permanency or emancipation. They have set up the M.Y Houses in alignment with Title 22 Regulation 88065.A.1&2. They have utilized block grants and Mental Health contract funding to cover the needs beyond the basic care rate. The Probation representative from Marin County shared that they only consider out-of-home care when the youth is a threat to the community at large. They utilize all possible support services, including WRAP, to the youth with their birth family with the goal of the youth not having to go into out-of-home care. Marin Probation gets pressure to move youth into group homes from the youth’s family members, schools, and the court. Alameda County has contracted with Seneca for family finding services as well as training and support. Similar to M.Y. House, Alameda County has to access Mental Health funding to supplement the AFDC rate to get the youth the services they need. Alameda originally contracted to serve youth in probation aged 8 to 12 years old in a hope to catch them young enough to avoid further probation involvement. Probation partnering with FFAs works much better when it is approached as a collaborative effort rather than a vendor-contractor relationship. There needs to be trust between Probation, the FFA, and the resource families. The panel also noted that it is really beneficial to have a joint RFP with Probation, the FFA, and Mental Health as partners under a single contract. The Marin Probation representative encouraged the Probation Departments to become less risk intolerant for new possibilities for serving their youth. The question was asked how much of the M.Y. House funding comes through Mental Health funds and, depending on the needs of the placed youth, it could be $1000 to $4000 a month from Mental Health funding.

The panel discussed the challenges of recruiting families to work with youth from probation, but the consensus in the room was that it is tough to recruit families for teens, period. The comment was made that adults who have had teens are tired of them and those that haven’t had teens are afraid of them. They have been trying reaching out to sports communities as well as faith-based communities. They encourage collaborative recruitment efforts. There was a concern expressed that there is no guarantee of FPRRS funding being on-going. A suggestion was made that counties and FFAs could contract with sales and marketing consultants, as well as social media experts.

Resource Family as Step Down

One of the biggest challenge is to find home based care for youth who have been arrested for sex offenses. Often they acted out within their family, so they cannot go home. Everyone was encouraged to read the police report regarding sex offenders because, at times, it was an 18-year-old boy who had sex with his 17-year-old girlfriend, rather than a molestation of a much younger child or rape. Research has shown that youth who step down from congregate care into permanency (birth family or adoption) have a much lower recidivism rate than youth who worked through various homes and levels of care.

What are the characteristics of families who succeed with teens? Seneca shared that they have had success with empty nesters and people who hold “family” as a strong value. They have also discovered that with M.Y. House, some families find it more amenable to make a commitment for six months than a long term placement. Support for families working with teens is critical. It was also shared that the CCR goal of stepping youth out of congregate care to home settings will likely take longer than CCR had hoped and that anyone would prefer.

CCOFFA MEMBERSHIP

CCOFFA sends newsletters out to all FFAs, whether they are members of CCOFFA or not. So, at times, because FFAs have been receiving the newsletters, they assumed they are members when they are not. Please check the list of CCOFFA members below if you are not sure if your FFA is a member or not. Membership is automatic upon request. We have no dues, fees, or requirements. To be honest, each FFA gets the same info from CCOFFA whether they are a member or not. Membership is about supporting the efforts of CCOFFA to keep all FFAs informed of dynamics that can impact FFAs in California.

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INFORMATION FROM THE 1/10/17 CCR PROBATION WORK GROUP

BUT FIRST, A QUICK UPDATE ON NTI (The National Adoption Competency Mental Health Training Initiative)

There was supposed to be a conference call in November about rolling out NTI in early 2017. Unfortunately, the person who was overseeing the Western states for the roll-out quit, so they are looking for a replacement and it has set back the roll-out for NTI. We are still waiting to hear about the next conference call. We will keep you posted as we get information.

CCR PROBATION WORK GROUP INFORMATION

This was the third Probation Work Group meeting that was open to non-Probation stakeholders. This Work Group is tasked with figuring out how to implement CCR and RFA with probation youth. Since quite a few probation youths are in group homes, there are parts of this meeting that have little bearing on FFAs. What is shared in this newsletter is focused more on what can apply to FFAs.

The meeting started with updates from Sara Rogers, Acting CCR Branch Chief:

The FFA interim standards were sent out late last year and all the FFAs were to submit their revised Program Statements/Plans of Operation by 1/1/17. To date, 114 FFAs (of 203) have submitted their revised Program Statements, but many lacked sufficient details regarding RFA items. CCL has “all hands on deck” reviewing the revised Program Statements and within 30 days should be calling the FFAs that have not submitted them, as well as those whose Program Statements missed the mark. Those FFAs will have 30 days to submit appropriate and thorough revisions.

Also, as part of RFA, each FFA office needs to have an individual ORI number and an assigned Custodian of Record to receive adoption level CORI (Criminal Offender Record Information) notifications. Only 150 out of over 400 FFA offices have applied so far. An agency cannot have families become RFA families without an ORI number for each office.

STRTP related: CDSS has not yet come up with the standards on how a STRTP could create RFA homes for children/youth stepping down to home-based care. It may be a while.

CCR/RFA wants FFAs and STRTPs to offer aftercare services for children/youth who are no longer in placement with them. CDSS has not yet developed how that funding would work. The funding would come from the counties and the state would like the counties to use the money they are saving by having kids out of congregate care and in home based care instead. Again, no one has figured out a structure that can make that happen.

Next, they had some County Probation official share things that have been working in their areas:

Orange County probation shared that they have been using wrap services as prevention services for both wards and non-wards. It is offered to everyone unless they refuse the service (see hand-outs). They also use wrap services to support step-downs from congregate to home based care. They currently have six organizations offering the wrap services. The have the Probation officers attend CFTs and, if possible, even wrap service meetings. They offer the services to non-wards for up to six months and to wards for up to 12 months or more. The youth has to start the services before they turn 18 years old in order to receive the services once they are 18 or older.

LA County has found that they now have much more collaboration between probation, Child Welfare and the providers. They are receiving the revised Program Statements electronically, section by section, rather than the entire Program Statement all at once. They find this way they can give feedback on each section as it comes in. They prefer this over receiving stacks of paper. They also have noticed that a number of the revised Program Statements sections are not complete. LA County Mental Health has been giving FFAs feedback about Mental Health contracts. LA County probation as attended the UC Davis CFT trainings and have found them useful, especially because tradition probation work did not give the youth a voice in the process. LA County is piloting TOPS (Treatment Offering Placement Stability) and will be done with the pilot in April. Since TOPS only addresses the child/youth’s well-being, but does not do risk assessment, they need to use their own tool for risk assessment as well. The biggest challenge with TOPS is you have to have all the data for it to be an effective tool, and it is a labor and time intensive effort. TOPS is helping probation to understand that a percentage of their youth have abuse and trauma as contributing factors to their behaviors and actions.

Shasta County shared that CCR has helped weed out providers that weren’t doing quality work with youth. They have found that the collaboration with Child Welfare has been helpful as well; they are now talking a couple of times a week. They were looking at a youth who was about to blow out of a local group home and would have been sent out-of-state, but they were able to offer support services and intervention with the anger/violence issue that was creating the 7-day notice and were able to help the youth to stay in the local group home.

A couple of group home providers shared what they are doing with probation youth. Since this discussion was strictly STRTP related, we will not share the details (unless you request them).

There was a discussion of ICPC (Interstate Compact on the Placement of Children) where youth are placed in group homes out-of-state, some as far away as Pennsylvania and Florida. There are currently 415 California youth placed out-of-state and the state is trying to research why those 415 cannot find a resource or group home placement in California.

Next the discussion shifted to working with families. Since 80% to 90% of probation youth return to their families of origin, that was the focus of this discussion. They shared that it is critical to develop a positive working relationship with the birth family to support a successful reunification – it is “a team based relationship.” They found that this process worked much better when the youth had a voice in the process and desired outcome. They assisted the birth families in order to reduce the barriers to reunification. With probation, they are often viewed as the enemy by the birth family, so this is a definite shift of approach. In discussing aftercare, they shared that successful reunification is harder if the youth has been in multiple placements, primarily because the youth becomes increasingly disconnected from their family. They shared that it is important to engage the birth family early and stay engaged.

Finally, there was a discussion about how FFAs and STRTP are to offer aftercare services, but the mandated staffing structure of a STRTP doesn’t allow the flexibility to work with the birth family and, as noted above, there is not a current funding structure for providing aftercare once a child/youth has left placement. If a child/youth is moved, and loses all the support people they have come to trust, the new provider has a hard time succeeding with the child/youth.

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CCOFFA MINI-NEWSLETTER

Hope you had a wonderful holiday season. Here we are in 2017 – CCR, RFA, accreditation and all. If you have no yet applied for accreditation with COA, CARF, or Joint Commission, please do so yesterday. Also, an FFA cannot apply any aspect of the new (RFA focused) interim standards until you have submitted your revised CCR/RFA aligned revised program statement and plan of operation to CCL and the counties you serve. CCOFFA has not attended any CCR meetings since mid-November, so that is why the number of newsletters has diminished lately. We also anticipate fewer CCR meetings and workgroup meetings in 2017, so we will likely have fewer newsletters in 2017 than 2016.

HOW ARE DIFFERENT FFAs HANDLING THE LEGALIZED MARIJUANA LAW?

This fall the voters of the state of California passed a law legalizing marijuana in California. This means each FFA needs to come up with policies about if and how they may deal with resource parents, adult residents, or visitors’ recreational marijuana use. In late November CCOFFA asked FFAs if they would be willing to share how their agency would be dealing with this. The responses we received are below. We are not sharing the names of the agencies, just their intended procedures.

Because the two regulations (FFA and smoking recreational marijuana) conflict, the smoking of marijuana is prohibited. FFA regs state you may NOT smoke on the premises of a foster home, inside nor outside. Marijuana regs state that you may ONLY smoke on your premises; so they cancelled each other out. Now, for edibles and other methods of use, I’m not sure. I would assume we would treat as alcohol and/or medications and lock them up.

Due to the new law, Proposition 64, we have decided to treat this such as alcohol. We will treat this with care and understanding but work to ensure proper education on not using in front of any children in their home (CFH) and using educational exercises to see train out foster parents on the importance of safely using and abstinence.

Well, since resource parents are birth parents/relatives too now and most of the children are being placed with birth parents and since most of these birth parents/relatives will be doing this, just my real rough guess, I would say, we are going to have to allow it, but it should be disclosed, an educational training on the effects documented and educational training for children school age and above.

Use will be considered the same as using alcohol.

“I wish retirement was a choice.”

Proposition 64 did not make marijuana use legal for recreational purposes, however what it does do is it sets the process in place for the state to begin developing the taxation and follow up systems. Prop 64 is said to be going into effect in January of 2018. I think I will be focusing on demonstrated knowledge skills and abilities as it relates to supervision issues.

I do know, for staff, our agency will follow Federal guidelines which insist on a clean pre-employment test. We ask the same for resource/foster parents but I am not sure how we will handle a situation of a report of or admission of use in the home recreationally, not in front of kids, etc

It is now in the same category as alcohol which foster parents aren’t prohibited to use socially. We will evaluate each case individually if the issue comes up. In a perfect world we would prefer that our FP be non-drinkers, or smokers, however our reality is some of them are occasional/social drinkers. Our policy now is that they cannot smoke in their house or around the FC, so this would apply to marijuana. We will include this topic in our training giving our preference and our policy around it if we decide to approve a home.

It is my thought to look at marijuana just like we do alcohol. We ask RP’s to keep their alcohol in their room, locked away from our clients. We educate them on the children’s possible alcohol and drug issues and their need to keep these substances away from the children. We also discuss and educate their need to be in a state to supervise our children, thus, being impaired by anything, alcohol, prescription drugs, or recreational drugs will inhibit such a state. For our employees, we do random drug testing and at this point, marijuana is a dirty test even if they have a medical card.

We will not be allowing recreational marijuana use in our programs. We Feel that the use of marijuana does not support the requirements to maintain eligibility for THP participants. Using marijuana recreationally limits your job search etc. and does not assist you in removing any barriers towards employment it creates barriers for future employment. It is also not legal until age 21 all our participants are under 21.

Shouldn’t override the smoke free environment regs and policies. Just decriminalizes the use.

We discourage drinking around the children now. When I was at the county, approximately 90% of the detentions was because of substance abuse and we did not want the children feeling anxious around foster parents who were drinking. We will also discourage foster parents from using marijuana around any children placed in their home.

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11/15/16 CCR PROBATION WORK GROUP

BUT FIRST, A PITCH FOR NTI (The National Adoption Competency Mental Health Training Initiative)

In CCOFFA’s 7/28/16 newsletter we shared that California is now one of 7 states that have been chosen to pilot NTI which is a FREE 20 hour (with CEUs) adoption competency training. The NTI group needs at least 200 people to take the full training and provide feedback. I have seen parts of the web-based training and it is very thorough and impressive. Under RFA, FFAs that do not have an adoption license still need to have adoption competent staff and your resource parents need to become adoption informed as well. This is an amazing opportunity for all of your staff to be trained for FREE. This training was developed by the organizations that developed ACT (Adoption Clinical Training) and TAC (Training for Adoption Competency), both nationally recognized, high quality trainings (I have taken both). As shared, at least 200 people need to take NTI, but there is no upper limit on how many people can take it. CCOFFA strongly recommends that FFAs (especially non-adoption FFAs) have their social work staff and supervisors take this course. If interested, please contact Theresa.thurmond@dss.ca.gov.

AN IMPORTANT PIECE OF INFORMATION ABOUT YOUR REVISED PROGRAM STATEMENTS

As we have shared, all FFAs are to submit their revised CCR/RFA compliant Program Statements to CCL and the counties they serve. If you serve, or plan to serve, probation youth, you need to also submit a copy of your revise Program Statement to the Probation Departments in an county from which you may accept probation youth.

11/15/16 CCR PROBATION WORK GROUP INFORMATION

This was the second Probation Work Group meeting that was open to non-Probation stakeholders. CCOFFA was not able to attend the first due to a prior commitment. This Work Group is tasked with figuring out how to implement CCR and RFA with probation youth.

The meeting started with updates from CCL (please see the CCL update attachment).

Prevention Services & Transition/Aftercare

Office of Child Abuse Prevention (OCAP) Angela Ponivas of OCAP shared that the goal of OCAP is child abuse prevention with the focus being children from newborn through age five. This age group is the primary focus because this is the age range that the majority of children come into the foster care system. They use three main strategies to achieve their goals: focus on children and families, trainings, and campaigns. Their approaches are need-based, results oriented, data informed, and evidence informed/based. They fund efforts to help counties and organizations meet these goals. Funding includes grants, contracts, and county allocations. They have an $88 million budget and 70% of their funding comes though C-CPSR (California Child and Family Services Review). The balance is federal monies and those are supported through the Child Abuse Prevention and Treatment Act (CAPTA), Community Based Child Abuse Prevention (CBCAP), and Promoting Safe and Stable Families (PSSF). They give $28 million towards tertiary prevention efforts. They have invested $35 million in 15 counties and 55 of 58 counties receive some type of OCAP funding. Each county is able to manage the funds differently and monies can serve both the children/youth, as well as the parents, if appropriate.

Wraparound services have been in California for about 20 years. It began as a prevention model to keep youth out of group homes and it now also helps youth stepping down out of congregate care. Now, wraparounds include aftercare to help keep family reunifications intact and they expect these services to expand through CFTs (Child Family Team meetings). Currently 47 counties offer wrap services and the State offers 4 day trainings on wrap services to the counties. An attendee from LA county commented that they have lots of wrap services offered there, but they see a wide range of quality of the services offered. They asked is there is some type of monitoring or quality assurance for organizations that offer wrap services. Wrap updated the standards in 2015. Some counties have fidelity models, but the State does not have a preferred tool for assessment of wrap services. A question was asked about capacity concerns with wrap services and wrap is funded in the counties through realignment money and how they use that money varies from county to county. A question was asked if there is research on the effectiveness of wrap for probation youth; that does not yet exist, but will be developed. A question was also asked about if the services offered are cultural sensitive, and there is not real data on that at this time.

Continuing of services and building capacity County Mental Health departments are implementing services in a variety of ways. Some provide all services themselves and other counties contract out a portion of the services. They will use CBOs (community based organizations) and/or the host county for out-of-county placed children/youth. It was mentioned that if child welfare, probation, and Mental Health will pool their funding, much more can be done. It was shared that it is important to access the most restricted forms of funding first (due to their very specific requirements) and to save the flexible funding to fill the gaps left behind by the restricted funding. A question was asked about if outcomes are being tracked for probation youth and it was pointed out that that the law mandates that there will be outcome tracking tools in place by 2019. They will be using information available through CCL and other sources. Two elements they are already starting to track for probation youth is the frequency of police involvement as well as how many probation youths are on psychotropic medications. A question was asked about how transitions and aftercare can be offered if a probation youth moves out-of-county. It was shared that there are many ways that Mental Health can keep offering support services and those can be offered by multiple providers. It was shared that many youth stepping down from congregate care really struggle with being back in the community at large, and the question was asked how the needed support will be funded. Traditionally, Probation has not accessed EPSDT (Early and Periodic Screening, Diagnostic and Treatment) funding. It was stressed that it is critical that youth gain access to services while in care so that the service can continue. There was a concern expressed that CFTs and other similar meetings are set up for the convenience of the adults rather than in the best interests of the youth. There were suggestions about utilizing technology (e.g.skype) or meeting in placed more convenient for the youth and their birth family such as libraries, community centers, and family resource centers.

CYC youth interview There was a brief explanation of CYC (California Youth Connection) that has been around for 30 years. CYC, working in conjunction with their statewide membership introduce one piece of legislation each year, as well as make policy recommendations. There are 33 chapters of CYC throughout the state. A former probation youth was interviewed. The youth shared that she intentionally got involved with Juvenile Justice so she would no longer have to live at home. She was asked what preventative services she had received and she mentioned Project What, which supports children/youth who have incarcerated parents, as well as ILSP and some job programs. She had been in a variety of placements including foster homes and group homes.

Funding strategies

EPSDT/medi-cal 50% of services can be funded through EPSDT and the rest is a match of counties monies. The mandate regarding EPSDT is not finite, but the funding is. County Mental Health operates on funding streams other than general fund monies. It was noted that other entities can offer services very similar to EPSDT. A challenge that County Mental Health faces it that the services they offer in the current year are funded by the revenue generate by the previous year’s services. They tend to be reimbursed for services 9 to 10 months after those services were delivered. The rates vary from county to county and the rate is based on cost and service delivery, which does not factor in pre and post service work. There are years when the current year’s needs exceed the revenue generated by the previous year’s services. The emphasis on accessing EPSDT services has resulted in over-medicalization of some of the dynamics of some children/youth.

MHSA (Mental Health Services Act) It was shared that MHSA funding is among the least restrictive funding available. Most counties (nearly all) have unspent MHSA funds. Each county has a MHSA steering committee that meets each month to make the funds available to the community. VERU few people in the room were aware of this. You can visit the MHSA website at http://www.dhcs.ca.gov/services/mh/Pages/MH_Prop63.aspx and visit the various pages to see what is available where, including the MHSA Components page. Every three years each county has to convene a commission for review of MHSA and how the funds are being used. On the website there is a page where you can access MHSA pertinent information for each county. It was noted that there can be a lot of competition for available MHSA dollars, but it is worth checking into.

CFT There was a review of current CFT information that has been frequently shared (including in the last CCOFFA newsletter). There will be an ACL about confidentiality issues around CFTs. The State is researching how other states have implemented CFTs and will be sharing their findings before too long. CYC asked who is going to inform the youth and providers about CFTs. Each county will determine how they will inform the youth and families. It was shared that it should be part of the role of the CFT facilitator. Birth families are supposed to be part of the CFT and it was asked if and NMD has the right to NOT have birth family present at their CFTs and the answer was that, as adults, they have the right to choose whether or not to have birth family attend. It was noted that the CFT team does not make the decisions regarding the child/youth, that is up to the placing worker and the county. It was shared that CFTs are very close, both in design and purpose, to TDM (Team Decision Making) meetings. It was affirmed that that view is accurate, although now CFTs are for all children/youth, not just those looking at going to a higher level of care.

Interagency Placement Committee and Shared Policy Leadership Please see the attached power point printout for the details shared – it is pretty self-explanatory.

The next CCR Probation Work Group will be on January 10, 2017.

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11/14/16 CCR STAKEHOLDERS MEETING

ACCREDITATION REMINDER

In all likelihood, this reminder is useless, but you only have 47 days to apply with either COA, CARF, or Joint Commission. If you have not done so yet, please make your choice and apply at the accreditation organization of your choice at your earliest possible convenience.

This meeting was primarily an update on important aspects of CCR, including RFA. Attached to this newsletter is a copy of the power point that was used, as well as a handout about the National Adoption Competency Mental Health Initiative.

fosterparentcollege.com The State recognized the need for additional training resources for resource parents, so they have contracted with fosterparentcollege.com (already on CCOFFA’s resource page on the website) and the state is paying the fees so that resource parents and agency staff can have free, unlimited access. It will be set up so that a FFA can track what trainings its families access and what courses they passed. The State still encourages face-to-face trainings that the FFAs offer and that counties offer through their own resources (e.g. Community colleges). There are a number of the courses offered in languages other than English and it is hoped the number of those courses will increase over time. The State is still determining which of the courses may qualify for the mandated pre-approval training topics. On December 7 and 8 there will be webinars better explaining this resource.

Therapeutic Foster Care Services There has been a notice sent out: ACIN number I-52-16E (http://www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acin/2016/I-52-_16E.pdf). The State is currently defining the framework for TFC (Treatment Foster Care) and that information regarding version 1 should be released in the next few weeks. They will also be revising the Medi-cal billing manual and that draft should be sent out in the next few weeks for feedback. The State is developing a Mental Health 101 and medi-cal billing training for the STRTPs since they have to have a Mental Health contract in order to operate as a STRTP. A representative shared that they are running into a problem because a child/youth will be placed in a TFC home, improve to the extent that the child/youth no longer requires TFC services, but the child wants to stay in that home and the family wants to keep them. There are then only two options: move the child/youth (which can be traumatizing) or reduce the rate the family is receiving for providing care. There is a capacity challenge to find sufficient homes for teens who will be stepping down from group homes/STRTPs and the State is seeing what other states have done to meet this challenge. The State will share what they have discovered in the coming months. It was noted that TFC is a service rather than a placement, so it would benefit FFAs to develop TFC services to support their families and placed children/youth. Also, Intensive Treatment Foster Care is being morphed into Intensive Service Foster Care. It was noted that those services can be offered to the resource parents as well as the placed children/youth. There are guidelines regarding the hours of training a current resource parent would need to become a TFC parent and that includes 40 hours of pre-approval training plus (I may be wrong on this number) 32 hours per year of on-going training.

Interim Licensing Standards The State has completed their “roadshows” to roll out the Interim Standards for both the FFAs and the STRTPs over the last few months. The main questions they received were regarding how to run two concurrent programs (CFH & RFA), how to convert current homes to RFA homes, how to access Mental Health services, and how to get the new RFA ORI number from the Department of Justice (DOJ). With FFAs that have an adoption licens and whose families have cleared for both foster care and adoption, they can continue to use their current ORI number, although RFA applications will need to be sent in for their current families. Questions were asked about the FFAs submitting their CCR compliant revised program statements and the State will be reviewing them and giving feedback; none will simply be approved. It was also shared that the revised program statement draft that FFAs will send to the State for review should also be sent to the counties they serve at the same time. For FFAs that serve multiple counties across a number of CCL regions, there will be one reviewer assigned to the agency, rather than multiple regional reviewers.

Education This is a new workgroup for CCR. It is SELPA (Special Education Local Plan Area) focused and is part of the County Implementation Team. The purpose of this workgroup is to explore the interplay between the schools, Mental Health, and CCR. They are also discussing the interface between IEPs and CFTs. They have had two meetings so far and one they have been focusing on can be found on pages 11 and 12 of the attached power point.

Mental Health Approval This section focused on the Mental Health contracts required of STRTPs. The information on this can be found on pages 13 and 14 of the power point.

Rate Structure Cheryl Treadwell of the Rates Bureau quickly reviewed the current rate transition plan that was outlined in ACL number 16-79 (http://www.cdss.ca.gov/lettersnotices/EntRes/getinfo/acl/2016/16-79.pdf) There will be a rate developed for a services only option a county may contract for with a FFA for non-FFA families. The Levels of Care (LOC) rates will not be implemented until Phase 2 due to automation not being in place to process the new rate structure. The Phase 2 ACL should be released by the end of November. The LOC will be based on dynamics in five domains: physical, health, education, behavioral/ emotional, and permanency. There will be static factors based on safety that could have a child/youth be determined to be a LOC 4 without having received lower LOC services first. The State anticipated having a LOC protocol training for the trainers in January of 2017.

RCL Group Home Extension was not addressed during the meeting (we were running late).

RFA All RFA forms (approved and draft) are on the RFA website (http://www.childsworld.ca.gov/PG3416.htm) There have been multiple county trainings on RFA and all 58 counties have implementation plans. The “hot topics” for the counties are out-of-county placement protocols and conversions of current families to RFA. A draft ACL will be going out within the week for feedback.

CCR Program and Services Implementation The probation workgroup has been meeting since July and just recently expanded the number of stakeholders attending the meeting (CCOFFA will have a newsletter regarding the 11/15/16 Probation Workgroup meeting either Wednesday or Thursday). It was noted that respite care has been expanded from 73 hours to up to 14 days in a month.

Performance and oversite The State is working on developing supplemental reporting language on the progress of CCR implementation. They are also developing youth satisfaction surveys as well as profiles of the youth currently placed in RCL group homes. They will be researching the youth’s ages and in which RCL levels they are placed. They are also working on developing tools to help clarify outcomes to define what success looks like. Indicators can include the number of interactions a child/youth has with police, as well as the number of children/youth on psychotropic medications. They again talked about the TOP (treatment outcome package) and CANS (child and adolescent needs and strengths) assessment tools. The two are currently being beta tested and an independent entity will be contracted to analyze the data. The State will have a recommendation regarding which to use, but it will NOT be mandated of the counties (although there will be a funding incentive to use the recommended assessment).

Tribal Consultation There will be an ACL regarding Tribal Consultation with Federally recognized tribes. It was indicated that stakeholders can include members from tribes that are not federally recognized.

California is one of 7 states that will be beta testing this free 20-hour adoption competency training (with free CEUs). An ACIN will be sent out with further details once the details are ironed out.

Interagency Placement Committee An Interagency Placement Committee has to meet any time a child/youth in a resource home is being considered for going into a STRTP. A team did a role play of what an IPC may look like. They noted that there is no required methodology required at an IPC meeting, but the member organizations are mandated. Represented were the facilitator, child welfare, the child/youth’s placing worker, probation. Education, the resource parent, Mental Health, the child/youth’s clinician, and a minute taker. The team did the role play for about 45 minutes to illustrate the issues to be addressed, options considered, and how a consensus could be met.

The next Stakeholders meeting will be on February 23, 2017.

AN EXCELLENT RESOURCE:

There is an excellent informational website The National Child Traumatic Stress Network at http://www.nctsn.org/ It is a great resource for helping your staff and resource parents to become better trauma informed.

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9/26/16 CCR MENTAL HEALTH WORK GROUP

MENTAL HEALTH SURVEY

During the meeting today, one of the main topics of conversation was the need for placed children youth who have mild to moderate needs (not on psychotropic meds, struggling, but not crashing and burning) having access to preventative, early intervention mental health services. 53 of the 58 California counties have County Mental Health Programs and it was stated that those programs offer preventative, early intervention mental health services.

The survey question is: are there counties where you serve in which it is difficult and/or challenging for your families and the children/youth in placement with mild to moderate needs to access preventative, early intervention mental health services? If so, which counties?

9/26/16 CCR MENTAL HEALTH WORK GROUP IFORMATION

This meeting carried quite a bit of gravitas – Will Lightbourne, Director of California Department of Social Services and Jennifer Kent, Director of the Department of Health Care Services were in attendance. There were also numerous top officials from many counties in person and on the phone.

The stated goal of this meeting was to create clarity regarding the mental health services that are available to foster children/youth. Following were the main topics of discussion during this meetings:

The attached Mental Health Referrals power point was created in 2014 and had been updated for this meeting, although the definitions are from the DSM IV and needs to be updated to DSM V. County Mental Health Plans do the initial screening and what services they may qualify for. The County Mental Health Plans can refer the assessment to licensed clinicians. If a child/youth meets the need for medical necessity, a plan for Specialized Mental Health Services can be put in place.

It was stated that disputes should first be discussed in CFTs (Child Family Teams). After some discussion, it was clarified that those disputes would be regarding the types of services the child/youth needs and by whom they may be provided. Any disputes regarding who is responsible for payment need to be settle between the primary providers and not in a CFT setting. It was emphasized that the determination of care for a child/youth needs to be made at the local county level.

In the three page Medi-Cal System handout, on page 2 it was pointed out that on item (2) “a reasonable probability a child will not progress developmentally as individually appropriate” which is a common challenge for children who have experienced trauma, but at no point in the document is “mild to moderate needs” stated. CDHS stated that the decision is made at the County level. It was then pointed out that it might better delineate between specialty and non-specialty mental health services rather than specialty mental health services and children/youth with mild to moderate needs.

A question was asked regarding the handout “CDSS Foster Care Clients by DHCS Delivery System” because the third box at the top of the table addresses “psychosocial services” but that term was in none of the other handouts or literature. It was clarified that it is a catch phrase that includes specialty mental health services. It was brought up that it would be helpful to have standardized language and terms among the different entities to provide clarity. For example, in social services, permanency for children/youth is the goal (so that every child may have a forever family), but in Mental Health permanency is that the individual is to receive mental health services for the rest of their lives and Mental Health does not want to do that. So the same word has extremely different meanings. It was suggested that to create even greater clarity that documents that explain mental health services, who provides them, and how to access them can be made specific to each entity in terms that the know and recognize.

A Public Health Nurse brought up that in their capacity, they frequently refer to fee-for-service (also referred to as fend-for-yourself) and these services do remain with the child/youth and a rarely disrupted.

There are counties where the County Mental Health Plan is contracting for mild-to-moderate services and a representative from LA county pointed out that the auditors that review all their financials need very clear definitions for all terms and a clear statement regarding who can provide specific services or they will disallow the costs. Clear definitions of what “mild to moderate” encompasses and who is contractually responsible for the services provided are needed. CHCS stated that the state would not oppose the counties contracting out some of the services.

A SELPA representative asked what can be done when the school system has a child/youth who needs mental health services and neither County Mental Health nor Managed Care will provide services? He stated that there is one SELPA that is facing bankruptcy because they have been paying out on mental health services for children/youth out of their budget. The Las County representative suggested that they contact their local District Attorney.

And, at the end, it was again requested to define what “mild to moderate” means for youth, since the legislation that addresses that issue only defines it for adults.

There were no further CCR Mental Health work group meetings announced.

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8/29/16 MENTAL HEALTH/CCR WORK GROUP INFORMATION, PLUS A UNIQUE RESOURCE FOR ADOPTIVE PARENTS

he Mental Health CCR work group had been meeting for a number of months and had been working through topics to determine clarity and direction for the impact of CCR on the Mental Health system. It was thought that this was likely the last of the work group meetings and there were four items on the agenda, all focused on supporting and serving children/youth in care with mild to moderate behaviors and needs. The topics for discussion were What is the role of the Managed Care Plan, What are the MOU requirements between the Managed Care Plans and the counties, How to engage the MCPs (Managed Care Plans) in this discussion, and Fee for Services for children in foster care.

I must give a disclaimer here – there was much discussion about the nuances, details, and in-workings of Mental Health services and Managed Care. Those topics are not my forte, so there is much that went over my head and I may not do a great job in relaying the particulars of the meeting. However, attached is the power point that was shared by the representatives from Managed Care and I will do my best to summarize the meeting as I understood it. Page references are for the pages of the printed power point. FYI, there were many county Mental Health representatives both in the room and on the conference call.

The Managed Care representatives began to go through the (attached) power point slides one-by-one. There are new Federal mandates now impacting Managed Care requirements and the plans are working on implementing them. In California, there are six types of Managed Care plans (page 2). Each plan has its own procedures for coordinating services. Managed Care is tasked with oversite of preventative health care services for all medi-cal recipients under the age of 21. This does include Developmental/Behavioral Assessment that covers developmental screening, autism screening, developmental surveillance, and psychosocial/behavioral assessment (page 4). It is the task of Managed Care to organize “member care and sharing information among all the participants concerned to achieve safe and more effective outcomes of care” which includes “specialty mental health.”

This is where the meeting got both interesting and quite confusing (and not just for me). One of the greater challenges this work group faces is that the laws and regulations regarding child welfare, Mental Health, Managed Care, and educational support/counseling/special educational systems were created at different times, by different entities and, from my perspective, it appears that the “powers that be” never compared notes. So, the bottom line (from my understanding) is that although it is clear that Mental Health comes into play when there is a significant mental health diagnoses, there is no clear flow of what services Managed Care can and will provide for foster children/youth with mild to moderate needs and what criteria would allow children/youth with mild to moderate needs to receive some short term mental health style services through Managed Care under the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program (page 4). Sara Rogers from the CCR division of CDSS is working hard to ensure children/youth of trauma have access to lower level (Managed Care) services as a preventative measure to keep them from decompensating and needing higher level specialty Mental Health services as a result of a significant diagnosis to what may have been a preventable event.

Education representatives also stressed that it is frequently in schools that many of the issues present themselves that result in a child/youth being referred to Managed Care or Mental Health Services. If there is an IEP, the school is mandated to provide services and, in some financially strapped counties, Managed Care and/or Mental Health will state that since the child/youth is receiving services, their help is not needed, leaving the school on their own, essentially providing mental health services without the support or funding.

There was a general consensus in the room that having CDSS, Mental Health, Managed Care, and Education in the same room discussing this issue was a long overdue and much needed. Karen Baylor of DHCS, who chairs the work group acknowledged that these issue and concerns do need to be worked through since the CCR deadline for implementation is 1/1/17 and much hinges on the gaps, questions, and details that need to be worked out in a collaborative effort by the different departments and divisions.

I cannot guarantee that my summary of the meeting is accurately representative of what occurred because I am under-informed regarding many of the nuances, nuts-and-bolts, and particulars of Mental Health and Managed Care. I hope my re-telling does not lead to any misunderstandings or significant errors.

A UNIQUE RESOURCE FOR ADOPTIVE PARENTS

It is not uncommon for adopting/adoptive parents to struggle with how to talk about adoption with the children in their home (both adoptive and birth). There is a website ADOPTION AT THE MOVIES that coaches adoptive parents how to use kid-friendly movies as an easily-accessible bridge into hard-to-access territory. Please visit http://www.adoptionlcsw.com/

As you either already know, or will soon come to know, accreditation requires ongoing clinically sound training for staff. How would you like the opportunity to have your staff take a high quality, evidenced based and informed, clinically focused 20-hour training, with CEUs, for FREE?

That is an opportunity FFAs in California have due to the National Adoption Competency Mental Health Training Initiative (National training Initiative or NTI for short). The Center for Adoption Support and Education (C.A.S.E.) is an organization dedicated to supporting best practicesandinnovation in the foster care/adoption industry and to provide premier resources and training to advance permanency for children and promote the healthy growth and development of families, nationally and internationally. They have long wanted to create a standardized, nationally applicable, adoption competency training and, with a RFP from the federal government, they now have that opportunity.

THE NATIONAL ADOPTION COMPENTENCY MENTAL HEALTH TRAINING INITIATIVE

C.A.S.E. and their partners, Children’s Bureau and the University of Maryland School of Social Work, have been working hard to make that training a reality and they are ready for the beta testing. They eventually will have the 20-hour Child Welfare focused training (which will come out in January 2017 – a date we are all very familiar with), a 23-hour child welfare supervisors training, a 25-hour mental health practitioner training, and a 4 session series on coaching for mental health practitioners. The overall goals of this series of trainings is to build capacity, improve outcomes, and to complement existing initiatives. When AB 1790 was passed in 2014, a primary goal was to remove barriers to permanency and when the state heard about NTI, they sought them out to see if California could be part of this initiative. NTI has been tasked with rolling out these trainings over the next year in 8 pilot states to “test” the trainings and receive feedback to fine tune and improve the trainings before the official national roll-out in 2019.

NTI wanted to make sure their 8 pilot states presented a broad range of populations, process, and structure with the goal of creating a final product that would work everywhere. California has been chosen as one of the 8 pilot states and with RFA, CCR, and accreditation fast upon us, a free training of this sort, at this time, is an amazing opportunity. With RFA, it is important for all FFAs to become adoption informed. What agency hasn’t had children adopted, whether it was by one of your parents or someone else? Don’t you want to support that success? The Adoption Competency Mental Health Initiative is a FREE evidence based and informed, and clinically competent, training with CEUs!. It is a godsend for FFAs.

Yes, I am “selling” this hard because I see incredible value for the FFAs in California at no cost. That is really helpful at a time when we are all spending more on accreditation and have less money available for clinical training. I am a graduate of both ACT (Adoption Clinical Training) and TAC (Training for Adoption Competency) and the people that created those trainings helped create NTI. Any agency that has taken ACT or TAC know that although the content has an adoption focus, the bulk of the information applies to all children/youth in care. The competency foci of the training include children’s mental health needs; attachment; race, culture, and diversity; loss and grief; trauma and brain development; positive identity formation; and promoting family stability pre and post placement. Increased competency of your staff on these key issues will help and support any child/youth in care, whether adoption is part of their case plan of not.

WHAT’S THE TRAINING LIKE AND WHAT’S IN IT?

During the meeting they showed us a number of parts of the training and it impressive in both presentation and content. This is not mere power point presentation or webinar; it is interesting and ”slick” in the best possible sense of that word. There is a ton of variety in the slides presented, lots of interactive functions, videos, with resources that can be opened and downloaded. Rather than give data which can become outdated, they give links to the sites that have the most current data. It is formatted so someone can’t just hit play on a video, walk away, and get created for 15 minutes of training. It is designed so the student is actively involved with the information being presented and the progress is monitored so that it someone takes a break from the training, when they open it up again, it goes to where they left off. BUT, you are not stuck only going through the material sequentially. There is a full menu on the right side of the screen and the student can go to any lesson at any time. This training is designed to be very practical, very pragmatic, and quite interesting.

WHAT’S THE CATCH?

NTI needs at least 200 students to complete the training in California in order to fulfill the requirements of the study. The good news is, there is no upper limit on the number of students. Literally, every FFA could have all of their social work staff and social work supervisors take the NTI training. There are three conditions: 1) an agency must have at least one social worker who serves children/youth in placement, plus their supervisor, take the training, 2) It is best if the participants complete the 20 hours of training in four months (5 at the most). That is just 5 hours of training a month, and 3) they need to give C.A.S.E feedback regarding their experience of the training and, most importantly, did the student’s manner of serving and supporting the children/youth and families change as a result of this training and, if so, how? That’s it.

As California FFAs, we can let other agencies and entities take part in the beta test of NTI and wait until 2019 for the final version, or we can have as many of our social work staff and supervisors as possible participate and get an incredible beta version first thing in 2017.

(I told you I would be biased)

SO, WHAT NEXT?

NTI will be working with the team of stakeholders that were invited to this meeting to create a State Implementation Team to determine who would be offered a chance at this and to work with NTI on the development of the roll-out and coordinating efforts for at least 200 students to complete the training and fulfill the three conditions outlined in the paragraph above. The good news is, FFAs are definitely part of that group that gets a chance to take the NTI training.

Again, the child welfare part of this training will be available in January of 2017 (yes, the same January 2017 with RFA, CCR, and having applied for accreditation). In the meantime, please talk this over with the leadership in your FFA. My bias is that every FFA could benefit from this, but you may not be so inclined, or you may want to have just one social worker and their supervisor take the training; obviously it is up to you. Later this year (I am not sure when) we will let you know when and how you can throw your hat in the ring to be part of this opportunity. We will keep you posted.

The official purpose for this committee is to “obtain input/recommendations on policy, best practices, and other aspects of CCR implementation.” Much of the 7/26 meeting was giving update in a number of areas.

Sara Rogers, of the CCR division of CDSS shared that CDSS had sent out an ACIN regarding AB 403 policies and implementations, including information about AB 1997 (which is in State Senate appropriations) which clarifies Mental Health integration, entrance criteria to a STRTP, plus some clarifications on RFA. Those are all statutory items. The interim written directives are in the final stages of development. They also released a RFA specific letter to the counties and sent out the county implementation guide along with the AB 403 ACINs with a lot of encouragement for the counties to collaborate with the providers in their county.

CDSS has been having regional convenings to keep the counties informed of the changes required by RFA and CCR to ensure there is truly a continuum of care at the county level. The convenings CDSS has had so far have been productive. Within a day or two a draft letter should be going out for review that talks about rate structure and level of care (LOC) protocols being developed, interim standards, and engaging in local implementation. See the attachment “CCR Updates.”

FYI, the handouts for this meeting will be attached to the email with this newsletter. Also, when I include all the handouts, the email becomes huge. So, from now on, newsletters with lots of attachments will be sent in zip files.

RATE STRUCTURE AND LEVEL OF CARE

Cheryl Treadwell of the CDSS Audit and Rates Bureau shared that they have a level of care assessment work group evaluating currently available tools that are used in specialty care. Their goal is to create a checklist approach to inform a level of care and subsequent rate. They are also looking at the number of type of youth that may be transitioning out of group homes into family settings. A group home extension letter is being developed that addresses requirements and expectations and should be released in a week or two. There will be another ACL released in about a week that that introduces the home-based and STRTP rate structure, along with the rates for TFC (previously ITFC).

There will also be a letter coming out about accreditation reimbursement that will explain the process and outlines the documentation that will be needed. Specifics regarding the criteria and time framework is still being developed. It should be done and released soon enough that as of August 1, 2016, agencies will be able to submit a request for up to $5000 reimbursement. This can be requested by agencies that have paid their accreditation fees on or after July 1, 2016.

MENTAL HEALTH PROGRAM APPROVAL/MEDI-CAL CERTIFICATION

All the information shared on this topic was in the 7/25 CCOFFA newsletter.

INTERIM STANDARDS

Sara Rogers shared that CDSS is progressing well in creating the interim standards. A copy of the revised FFA regulations for review should be sent to stakeholders within the week. Version 3 of the RFA will also be going out for review. The STRTP interim standards are expected to be released for public comment in August. Also, the outline for Program Statements will also be sent out soon for review. Sara shared that the format for Program Statements is going to look quite different with a strong emphasis on how an agency will access services for the children/youth they serve. Under AB 1997, if an agency has not submitted its updated Program Statement to CCL by 1/1/17. They can continue to work with the families they already have, they will not be able to approve any new families until the updated Program Statement has been submitted. FFAs do have until 12/31/18 to submit their updated Program Statement, but would not be able to approve new families or get the new provisional rate until the update has been submitted to CCL.

REGIONAL CONVENING/LOCAL IMPLEMENTATION

As noted above, CDSS has scheduled regional technical assistance convenings targeting county and state staff for all the various departments and divisions that will be impacted by, and participating in, CCR and RFA. Eventually, these convenings will be open to providers as well, but the focus right now is getting all the state and county elements up to speed with CCR and RFA and providing technical assistance for the implementation of CCR at the local level.

Q & A TIME

The meeting was then opened up to a question and answer session on any of the items addressed above:

During the transition time of group homes becoming STRTPs, can a transitioning group home have youth both under the RCL funding structure and the STRTP funding structure? The response was, “It still needs to be teased out.” A request was made that the upcoming Mental Health Certification ACL specifically address this question, even if to say it is being looked at.

It was shared that soon the interim standards and version 3 of the written directives would both be released soon. Is there a difference? The written directives are specifically written for the counties’ implementation (although a section talks about the families). That is why there is a large section about county-based due process. FFAs are addressed in the interim standards and the standards are what FFAs should focus on. When version 3 of the written directives is released, there will be an explanation of the differences between version 2.1 and version 3. CDSS is targeting to releases bot for review by early August so they can receive feedback by August 15, so the final releases can happen on August 30.

Regarding the upcoming CFT letter, concern was expressed that it recurrently refers to family, but rarely refers to parent. A large part of CCR is, whenever possible, a child/youth is reunified with their birth parent. It was requested that “parent” is put into the document as needed.

Does and agency have to have a separate Program Statement for each program they have? No, each can be included as part of the single Program Statement. One shift of focus with the new approach to Program Statements is it is important to address how the children/youth will be served.

The question was asked what to do with youth in group homes where the group home can’t or won’t transition to a STRTP, what happens if there are no homes for the child/youth to go? That is part of the reason an extension can be granted to a group home. (Up to 2 years if they extension is requested by a county; it can be longer if requested by probation.)

YOUTH ENGAGEMENT

CYC in conjunction with Youth Engagement Project had a full day convening on how to better inform children/youth in care about CCR. The youth felt it was important that children/youth understand that CCR is something that thy are part of, rather than it being something that is done to them. Please read the following attachments for the pertinent information: “Youth Engagement in Continuum of Care Reform Convening” and the handouts starting with “Continuum of Care Reform, For a Better Foster Care System.”

The question was asked if the FFAs and Group Homes are having conversations with their children/youth in care about CCR. One respondent on the phones shared that they have not because there is so much that is still unknown to the FFA. Also, sometimes they get wrong or incomplete information and they do not want to pass on inaccurate information to the children/youth. At this point, without knowing what LOC a child/youth may qualify for, they are not even sure what funds they will have available for services. The response from the California Youth Connection representative was that FFAs should be as transparent as possible and stress that these changes are intended to improve the foster care system. It is much better to talk with the youth than simply talk about them. It was also stressed that even if a child/youth’s situation is such that they may not feel much of a change due to CCR or RFA, still let them know because it may impact one of their siblings in care elsewhere.

TARGETED RECRUITMENT/PERMANENCY SUPPORTS PRESENTATION

There was a panel discussion with representatives from Sacramento County, Families Now, and Sierra Forever Families to address targeted recruitment. Please see the following attachments for important information: “Targeted Recruitment/Permanency Supports Presentation Panel” and “Recruitment and Retention of Resource and Permanent Families.”

Sacramento County partnered with a couple of adoption FFAs to find adoptive homes for youth coming out of group homes. They stressed that is a unique opportunity to recruit for a specific child, rather than recruiting families for a specific age and gender. They shared that public private partnerships are extremely helpful in this type of recruitment. Sierra Forever Families partnered with Sacramento County for the “Destination Family” program. They focused on children/youth that had been in care for two years and had not found permanency. They reviewed five youth each month.

The philosophy is that every child needs a permanent family relationship, even if it is not a legal arrangement. There is no child that is unadoptable and those children/youth that say they are not interested are not interested in being rejected yet again. They shared that it takes two to three years of a dedicated worker working with a child/youth in a supportive manner to open up the possibility of adoption for a child/youth who is afraid of being rejected again.

A single gay foster father shared his story of how he shifted from wanting a toddler to adopting a teen who is transgender. His adopted daughter was part of the panel. He shared his story with both candor and humor. He shared that he had no interest in adopting a teen until he said he was willing to meet a specific teen. They immediately clicked and eventually he adopted her.

African American and LGBT children/youth are over represented in the foster care system, and especially in group homes and need caring families to adopt them – emotionally if not legally. Relational permanence does not mean a child/youth has to live with the person that will love them for life.

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7/25/16 CCR MENTAL HEALTH WORKGROUP MEETING INFORMATION

CFTs

One of the foci of the meeting was to look at CFTs, what are the guiding principles and expectations for them, and what is Mental Health’s role. Planning meetings for the child/youth and involving the birth family are not a new idea. AB403 requires that CTFs are held to inform the case plan for a child/youth in care and address potential changes in services and/or placement. CDSS is currently drafting a letter to the counties regarding the funding for CFTs and how they are to support the core models of child welfare and Pathways to Wellbeing (Katie A). The goal of giving counties additional funding is to assure high quality CFTs.

The draft of the funding letter is expected to go out to stakeholders within a day or two for feedback. AB 403 put the placing agencies, welfare or probation, in charge of setting up the CFTs. It is anticipated that a child/youth will have their first CFT within 60 days of coming into care, and then as needed. There has been discussion about regularly scheduled CFTs, but they are really supposed to be driven by the needs of the child/youth rather than a calendar. CDSS will be giving classes on CFT and are working on the requisite documents.

There was quite a bit of discussion regarding whether education will be a part of CFTs. The general consensus is that there should be educational representation, be it a teacher, school counselor, class aide, or administrator. The greater challenge will be scheduling a CFT so an education representative could attend. It was noted that general education teachers may not attend, but it would be best if special education teachers attend due to the needs of the child/youth. In LA county, they have been working hard at implementing CFTs and they discovered that when funding is available for educational representatives to attend, they showed up, but when the funding went away, they quit attending. An educational representative stated that it would be good for teachers to be made aware of CFTs so they have the opportunity to attend.

Additional information regarding CFTs:

Parent partners will be allowed to be part of a CFT.

As noted, there is funding for CFTs, but the Child Welfare allocations are yet to be determined.

Mental Health has also received funding to support their participation in CFTs.

The question was asked if the ACL creates a mandate for education, or any other entity, regarding CFTs. The answer was that the ACLs only create a mandate for the counties.

It was shared that San Francisco county has done well implementing CFTs and it was suggested that CDSS contact them for feedback. The biggest challenge has been the logistics of getting all of the critical people to a CFT at the same time. They have even had the individuals share calendars so workable dates could be found. Once of the critical aspects of CFTs is collaboration ant it may be necessary for some CFT participants to be there via conference call.

Someone asked what the “endgame” is for CFT. Sara Rogers shared that the endgame is to meet the needs of the child/youth with the goal of permanency.

A representative from Uplift, which is an early implementing FFA, shared that the children/youth we serve have more complex cases and it is likely that there will be a core CFT team of 5 or 6 individuals who will make determinations from the feedback of the other participants. There will also need to be developmental considerations for children too young to actively participate in a CFT.

It was agreed that it is very important for the provider to be present at CFTs, as well as critical Mental Health representatives.

There was concern expressed that CFTs need to have permanency competent individuals present during decision making since much damage has been done when decisions were made by people not aware of permanency and adoption dynamics, and some decision have made things far worse for the children/youth and have even disrupted adoptions.

FFAs AND “MEDI-CAL 101”

The Department of Health Care Services (DHCS) plans to help FFAs and group homes learn about the required Mental Health certifications (program and medi-cal) and specialized mental health services. They are discussing using webinars and/or live classes. Possible topics include medical necessity, qualified services, how to obtain medi-cal certification, contracting, documentation, and training. They are still working on when these trainings would be offered and how many would be offered.

One of the greater challenges is that mental health service is complex and there is a lot of variety of expectations, requirements, and opportunities between counties. The biggest gaps for FFAs that have not yet worked with specialized mental health services is the necessary business model, which includes quality management and disallowances (where services are provided but the FFA finds out later they did not qualify for payment). Also, since providing a specialized mental health service is very expensive due to a broad range of requirements and expectations, as well as the required staff, a program that serves a small number of children/youth (20 for example) will lose money on that service.

A representative from a smaller county shared that they have just 5 children who qualify for managed mental health care and they are in three different resource homes. It takes larger FFAs with additional programs to help serve these children/youth properly.

It was shared that the higher level of care provided for a child/youth, the more it makes sense for the provider to offer those services directly (e.g a TFC program).

In response to Katie A, LA county has been geomapping where children/youth are placed and knowing what mental health services are readily available and by whom they are offered.

This lead to a discussion about how a FFA can obtain the necessary information regarding a new placement in order to have a Needs and Services Plan that serves the child/youth well and supports the goals established in the child/youth’s CFTs. FYI, “Needs and Service Plan” is a foreign term to Mental Health. It was suggested that the focus of a child/youth’s first CFT would be to gain all necessary information to create an appropriate individualized plan. It was shared that FFAs commonly get little information regarding a child/youth at time of placement and it is not uncommon for it to be quite difficult to get information after that from the county. There are times that FFAs are told by county representatives that due to confidentiality, they cannot share information about the child/youth that was just placed with the FFA. There needs to be a way to ensure that the FFAs get the necessary information regarding a child/youth in a timely manner so they may help meet the permanency goals for that child/youth.

It was shared that, at times, county counsel can be overly conservative about what a county is to do and the ACLs and ACINs are very helpful.

There also was discussion about how, depending on the counties, certain wrap services can be “locked up” by a few providers. leaving no opportunities for other FFAs to offer similar services. For smaller FFAs without licensed staff, they have no idea if they have anything to offer that the county would want. It would be helpful if county Mental Health could share what services are fully provided and which need providers.

A mental health representative also shared that if county Mental Health explains all the challenges of creating a specialized mental health service and the accompanying business model it requires; it can appear to the FFAs as if Mental Health is coming up with excuses to not work with them. It was suggested that the State take the role of informing FFAs the challenges, requirements, and expectations that come with offering specialized mental health services. Also, it was shared that if an FFA does not set up their service well, much of the work falls on the Mental Health Provider.

This meeting’s agenda ended up with a large portion being dedicated to STRTP (short-term residential therapeutic program) issues. Group homes are not a focus of CCOFFA, but since a number of FFAs also have a group home division, that information will be included in this newsletter. However, it will start with FFA related items and then the STRTP items, so feel free to stop reading when we get to the STRTP section.

The meeting began with updates from Sara Rogers, Bureau Chief for the CCR Division of CDSS:

There have recently been a number of All County Information Notices regarding CCR.

AB 1997 is a bill that clarifies a number of issues within CCR and is currently being reviewed by the State Senate Appropriations Committee. For FFAs, Mental Health contracts are NOT mandated or required; however, FFAs must engage with their county Mental Health to know who is providing what services locally. There is a plan to develop a Technical Support Division for information and communications. To review the bill, go to: http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB1997

Counties will be receiving budget funds for foster parent recruitment and retention and Sara Rogers encouraged the FFAs to see how they may able to partner with their counties in these efforts.

Also an ACIN was sent to the counties encouraging them to work with their providers on the various aspect of RFA and CCR.

There will soon be a letter coming out giving clarification and guidance regarding CFTs (Child Family Team meetings) with the goal of having quality CFTs. The draft of the letter will be available for public review in a few days.

CDSS is still working on the interim standards for CCR and they hope to have the FFA standards out in early August and the STRTP standards will come out later for public review. The standards will then be adjusted as needed based on the feedback received.

The Mental Health workgroup is working on the medical necessity criteria, as well as discussions on trauma and how trauma may qualify as medical necessity. Also being discussed is how children/youth with mild to moderate needs can access managed care or fee for service. They are also working on a FAQ info sheet. Please send any questions for the FAQ to Theresa Thurmond at thurmond@dss.ca.gov

CDSS is working on a letter clarifying FFAs requesting reimbursement towards their accreditation costs. FFAs that completed the process in the last two years in anticipation of the requirement asked if they could file for reimbursement as well. That topic is being discussed at CDSS.

REQUIREMENT FOR COUNTY REVIEW OF UPDATED FFA PROGRAM STATEMENTS AND PROGRAM STATEMENTS FOR NEW FFAs

Rami Chand, with the CCR Division Program and Services, shared information regarding the requirement for County review of updated FFA Program Statements and Program Statements for new FFAs (see attached Sec. 13. Section 1506.1, Program Statement Review Process, and sample request letter). With RFA and CCR, all existing FFAs need to update their Program Statements and a copy of those updated Program Statements must be sent to each county in which they have offices and from which they receive placement referrals. That review needs to also include a request for a letter of recommendation. The good news is that a FFA only needs one single letter of recommendation, regardless of how many counties they serve, to continue functioning. Also, that recommendation can come from any county and does not need to be from the county or counties in which they have offices. The bad news is, if an existing or new FFA cannot get a single letter of recommendation, they will not be able to access AFDC funding, and thereby will have to close their doors. A letter of support is considered the same thing as a letter of recommendation. Please note, since this letter of recommendation is based on the updated Program Statement, current letters of support will not fulfill this requirement. The counties have requested that they get to see of any letters of non-support issued for an FFA and CDSS is considering that request.

Additional issues and questions included:

Some FFAs are not accepting placements from the county in which they have an office, and that is a concern to those counties.

Some FFAs have shared that they have been trying to engage with their counties and the county either has not cooperated or are not sufficiently progressed in RFA and CCR to engage in conversations with the FFAS. It was suggested that each county have a specific contact person to engage the FFAs in the changes taking place. There will be a ACIN (All County Information Notice) again encouraging the counties to engage he FFAs that support them regarding all the upcoming changes.

There was a question whether CDSS was still issuing state-wide adoption licenses to larger adoption FFAs that serve multiple counties, and the answer was, yes; there have been no changes to that.

Since CCL will be flooded with updated Program Statements from 207 FFAs, they will obviously not be able to review them all by 1/1/17. So, all FFAs that submit their updated Program Statements prior to 1/1/17 will start receiving the new rates on a provisional basis until CCL has had the chance to review their updated Program Statement.

RATES UPDATE

The Audit and Rates Bureau is working on an assessment protocol that will help determine the level of care (LOC) and subsequent applicable rate. This is NOT the same as CAN or TOPS assessment, which is an assessment of the child/youth; this is an assessment protocol regarding what types of needs qualify for the four levels of care (LOC). Five core domains were determined that will factor into the assessment protocol, but the details are still being worked out.

Someone asked if the CFTs (Child Family Team) meetings will determine the level of care (LOC). The answer was that it will not determine the LOC, but will help inform the final determination.

MENTAL HEALTH APPROVAL INFORMATION

There were two representatives from the Department of Health Care Services (DHCS) to discuss Mental Health Program approval. The vast majority of what they shared was regarding STRTPs and is addressed below. They did share that FFAs do NOT need Mental Health Program Approval, but just the Medi-cal billing approval, which needs to be renewed every 3 years. If FFAs have wrap or day treatment centers, those may require additional approvals.

For FFAs that do or plan to have TFC, they will need to apply for a NPI (National Provider Index) number. Evidently, it is very easy to apply for a NPI number and does not take much time.

Under AB 1299, “presumptive transfers” are being worked out so a child/youth placed in a county other than the county of origin can receive Mental Services from their county of residence.

As shared above, most of this meeting dealt with STRTP specific information and CCOFFA’s focus is on FFAs. However, since a number of FFAs also have group homes, we will share the more important information:

AB 1997 includes clarifications of on Mental Health provisions for STRTPs, including the fact that they need both a Mental Health Program certification, as well as a medi-cal billing certification. Group homes that intend to become STRTPs need a count of their youth placed that require specialized Mental Health services.

The new rate structure letter regarding the 1/1/17 roll-out for STRTPs has been drafted which includes a range pf rates based on the level of services provided. The CWDA (County Welfare Directors Association) is reviewing the draft.

AB 403 is requiring significant changes for group homes, so a group home can have a county ask for an extension for that group home beyond the 1/1/17 start date to give them time to convert to a STRTP. Yes, you read that right – a county has to ask on behalf of a group home. There is a draft letter being developed. The letter will be reviewed by the Audit and Rates Bureau which will check to see if the county is working on developing capacity for step down youth and they will look at the history of the group home as well. A request from a county can end up with a two-year extension. At this point, there is no time limit on an extension requested by probation. A group home cannot ask for the extension for themselves. There will be clarification letters coming out regarding Mental Health certifications and new program statements. CDWA is reviewing those letters and a third letter regarding accreditation is being drafted.

Regarding group homes getting an extension to convert to STRTPs, they will continue to receive the current RCL rates until they convert to a STRTP. Unless a group home either successfully converts to a STRTP or has a county they serve request an extension before they end of 2016, they will no longer be funded.

There are discussions between CDSS and the counties about to transition youth out of the group homes that are not planning on converting to STRTP or asking for an extension.

Someone asked about the rumor that group homes, as they currently are, will continue to exist. Only Regional Center client and educationally funded group homes can continue under the current system. Any group home that receives AFDC funding will need to convert or eventually close.

Once the new written standards for STRTPs are written, CDSS will hold regional meetings to inform, clarify, and answer questions and concerns.

Someone asked if, during the transition to a STRTP, if a group home can have a mix of group home youth under the RCL system and other clients under the STRTP funding. CDSS stated that the issue is being discussed currently.

It was noted that a group home cannot offer Mental Health specialized services without Mental Health Program and Medi-cal billing certifications. Similar to FFAs under CCR, if a group home cannot provide the services, they do have to have access to them.

Provisional approvals will be given to group homes actively transitioning to STRTPs. However, their annuals will be based on the date of their site visit for STRTP approval.

This is not a thorough list of the STRTP issues discussed at this meeting, but an overview of the main points.

ACCREDITATION ADVICE FROM AN FFA

Dear Colleagues:

I know everyone is extremely stressed with the CCR changes and with accreditation. However, I want to take a moment to encourage you to breath, take one step at a time, and we will get through this! I just submitted our application to CARF, which will be here in Oct/Nov of this year to the tune of $13,000 (to survey 4 different sites and about 80 placements) to give other agencies a frame of reference, it feels like a kick in the gut. I know for you larger organizations this is a small number, but it is all comparable.

With that said, I do want to take a moment to discuss with you the value of our organizations going a quantitative route with our ETO (Efforts to Outcomes) measures. In order for our industry to prove our worth, I believe it is imperative to have actual data, which proves our worth and for which we can justify our rates. I know going with a data management system seems overwhelming, but if you consider the cost of hiring a compliance officer versus the cost of implementing a system….

I have gone with two data management systems, which CARF is loving . The Apricot system by Social Solutions, which tracks all of our ETO and with Relias Learning, which tracks all of our training and has a huge wealth of online training, CEUs, and the ability for your organization to upload your own trainings, which can be accessed from anywhere. I have also been working with MediCaid in the State of Nevada for 10 years now (this is for those who are pursuing your mental health certificates), and when they heard I had with Relias, their QPI agent just said, send me your print outs for their auditing records. Trust me MediCaid audits are brutal!.

I also want to highlight that my organization just procured two grants, which total $140,000 (which paid for both of these systems), because we HAVE these systems. Without question, we would not have received these grants. These two systems were the corner stones to the grants and why we beat out 40 other organizations, which had also applied for the grants. Therefore, I want you to consider the long-term implications and the vision of what these systems will bring to your organization. The mom and pop way of running our businesses is no longer the mode of operandi, and I fear those which do not consider these methods will be left behind. I am more than willing to discuss any of this with those who are still questioning what to do. My organization has spent months researching these options.

For those of you who want to contact the companies directly, here is the contact info.

Chad Moody, an excellent and hard working individual for Relias Learning: email – cmoody@reliaslearning.com or phone is (919) 655-7851

Social Solutions, Jessica, another hard working individual, email: jeichler@socialsolutions.com Do not have a direct phone number for her, but can get you one if you want it

If you have any questions or concerns regarding RFA, you can email the state directly at rfa@dss.ca.gov

Or concerns regarding CCR at ccr@dss.ca.gov. Please remember, many of the specifics regarding RFA, and especially CCR, are still being worked out.

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INFORMATION FROM THE 6/29/16 CCR MENTAL HEALTH SUB-WORK GROUP MEETING

The Mental Health sub-group meeting was facilitated by Karen Baylor from the Department of Health Care Services and Sara Rogers from the CCR division of the California Department of Social Services. The primary foci of the work group for the next number of meetings is 1) medical necessity criteria, 2) Child and Family Teams (CFTs), 3) the FFAs’ roles in working in conjunction with Mental Health services, and 4) how to provide care for children/youth with mild to moderate needs (who do not meet the criteria for receiving specialized Mental Health services). The discussion on medical necessity filled the entire two-hour meeting.

Attached are the hand-outs from the meeting: Title 9, 1830.205 (medical necessity criteria for Specialty Mental Health Services), “For a child who meets the criteria of Section 1830.210(1)”, 1830.210 Medical necessity Criteria..for under 21 Years of Age, Mental Health Service Responsibilities, Brief Overview of Specialty Mental Health Services, and Pathways to Mental Health Services Acronyms.

There were numerous County Mental Health representatives in the room and on the phone for this meeting. Following are the main points addressed during this meeting:

There is a challenge with children/youth in care who seem to meet medical necessity, but the Mental Health assessments say they don’t. This is particularly true for youth who are currently in group homes (STRTPs). They will need to meet medical necessity in order to be placed in the new STRTPs, which will all be level 14 homes. Because of this breakdown, the STRTPs are the first to feel the impact of required medical necessity. At this point, there are number of youths in level 10 and 11 homes, and probably only about half will meet the needs criteria to go into a level 14 STRTP; the rest will need to step down into a less restrictive level of care (resource homes).

The first hand-out, Title 9, 1830.205, is a list of qualified Mental Health diagnoses. However, there are 21 managed care providers in the state and there is a range of assessment criteria for each, and they don’t all align.

How does a child/youth qualify for medical necessity? One of the Mental Health experts in the room shared that the specific referral process may differ county to county. However, when a request for services is received, there will be an initial screening followed by the first assessment to determine necessity based on symptoms and, most importantly, impairments to the ability to function in life. If there is no impairment, the criteria will not be met. If there are impairments, a treatment plan will be developed with local resources in mind. A thorough assessment can take weeks or months, so a treatment plan can change. If the level of disturbance is endangering to themselves or others, they will likely be hospitalized. For children, a major criterion is if they are able to cooperate with the help offered.

There is the understanding that children/youth in care have experienced trauma, but there needs to be consistency developed regarding the definition of medical necessity in light of that fact.

There was concern expressed regarding the 1830.205 list for medical necessity because of a number of the criteria are rather vague, leading to some children/youth not gaining needed entry into the Mental health system. A child/youth has to “fail first” in order to qualify and there is no actual funding regarding prevention.

Sara Rogers asked, “Are we sure we can’t diagnose it?” The response was that clinicians don’t like to label a child/youth unless necessary.

There is an ongoing concern because approximately 60% of children/youth in care have mild to moderate challenges and therefore do not qualify for specialized Mental Health services, yet they still need help.

There was a concern noted that the 1830.205 list does not list Oppositional Defiant Disorder or Conduct Disorder, so children/youth with those issues do not qualify, while 1830.205 does include disruptive behavior; so why doesn’t ODD and CD qualify?

Therapeutic Behavioral Services (TBS) is a supplemental service to EPSDT (Early and Periodic Screening, Diagnostic and Treatment) so there must be other specialized Mental Health services also being offered. TBS cannot be offered as a standalone service.

A Mental Health clinician on the phone expressed concern because none of the 21 managed care providers are willing to come to the rural, more sparsely populated counties.

Someone brought up autism and a clinician pointed out that snice autism is neurologically-based, it does not fit into the Mental Health criteria.

A concern was expressed about a child/youth being labeled due to a transitory incident. A Mental Health clinician shared that they can give a provisional diagnosis that can open a child/youth to service without labeling them permanently.

Concern was expressed from three different people about a child/youth being diagnosed and labeled, when the real cause for their current distress may be that their resource parent may not be fully trained or aware of the impacts of trauma, or in the case of LGBT youth, not accepting of them, so their care may be exasperating a child’s trauma, rather than the child decompensating due to their own internal struggles. CCR does not want a child moved, yet if the skill of the resource parent isn’t meeting their need… It was noted that the CFT (Child Family Team) meeting would be vital in a situation like this.

The question was asked if there will be a merging of the current bifurcated system of fee for service and managed care? That dual system is expected to continue.

A concern was shared that since a valid first assessment can take weeks or months. a youth needing a STRTP could be moved to a number of homes unable to meet their needs prior to an assessment being completed. Sara Rogers shared that there are emergency provisions that allow a youth to go into a STRTP if needed while the assessment is still in process to limit the number of moves.

Another question was raised about 1830.205 regarding 2(b) as one of the entry criteria – “A reasonable probability of significant deterioration in an important area of functioning.” Child Welfare often refers to that for a child/youth to gain services and it was stated that it would be very helpful for the Mental Health side if there could be clarification and technical support with that definition. The question was also asked if there is a mechanism for tracking a child/youth to see if they are improving. The challenge is that the current system is problem-based, so it doesn’t currently document for improvement. DHCS will need to provide clarity.

This one I am not clear on – it appears that a child/youth may fit the criteria for Specialized Mental Health services, but still may not qualify for specific medical services. They are two different things, so a child/youth may get entry, but not services.

There was a question about what Specialized Mental Health Services a child/youth needs to be receiving in order to qualify being placed in a STRTP. Those do need to be defined by a clinician, but entry can be provided through a variety of sources. The CFTs really need to be the deciding factor in a child/youth being referred to a STRTP.

With STRTPs the goal is very much the ST (short term). It is hoped that no child/youth will need to be in a STRTP longer than 12 months.

A concern was expressed that 1830.205 is written regarding adults – not children and youth, so the criteria does not work particularly well for them.

Sara Rogers shared that CCR provides “substantive” funding so that CFTs can do the job they are intended to.

A representative from California Youth Connection asked what can be done when a child/youth was misdiagnosed? It was noted that diagnoses can be defined as provisional or transitory, so they need not be a life-long label.

I am not a Mental Health clinician – I did my best to represent what was shared in the room. I apologize if any of my explanations missed the mark.

If you have any questions or concerns regarding RFA, you can email the state directly at rfa@dss.ca.gov

Or concerns regarding CCR at ccr@dss.ca.gov. Please remember, all the specifics regarding RFA and CCR are still being worked out.

SOME INFORMATION FROM THE 5/16/16 CCR MENTAL HEALTH SUB-WORK GROUP MEETING AND ACCREDITATION ADVICE

CCOFFA CLARIFICATION:

I, Jerry Johnson, am the sole coordinator for the California Coalition of Foster Family Agencies (CCOFFA). As such, I am wholly and solely responsible for the production and content of the CCOFFA newsletter and any other CCOFFA related communications, whether by phone, email, or other means. I am employed by an FFA, but any communications on my part on behalf of CCOFFA should not be viewed as reflective of the opinions, views, or preferences of the FFA for which I work.

5/16/16 CCR MENTAL HEALTH SUB-WORK GROUP MEETING

The Mental Health sub-group meeting began with some updates from Sara Rogers, acting chief of the Child and Youth Permanency Branch:

CDSS will soon be sending out clearer definitions of the Levels of Care (LOC) referred to in the new FFA rate structure.

CDSS is on target for a June release of the new Program Statement guidelines to support the FFAs in enhancing their current program statements to meet the requirements of both RFA and CCR.

In the May revision of the State budget, Mental Health was additionally funded to be able to send Mental Health representatives to CFT (child family team) meetings for assessment and support of children/youth who are receiving Mental Health Services. Please note, not every child/youth in placement will need a mental health representative at their CTF meetings.

CCR requires an assessment of each child/youth which will help define the Level of Care (LOC) they require. There are currently 6-month trial runs of select counties using CANS (Child and Adolescent Needs and Strengths) and TOP (Treatment Outcome Package) to determine a child/youth’s required Level of Care (LOC). At the end of the 6-month trial period, the data will be analyzed to determine which method works best for determining Level of Care. Whether CDSS decides to use CANS or TOP, these are not a replacement for a Mental Health assessment.

In response to CCR requirements, the Mental Health Services Division has identified 12 issues that will require examination and work to come under compliance with CCR. The 12 issues are:

A primary topic of conversation was concerns regarding capacity, including having permanency/ adoption options for the youth that will be stepping down from STRTP placements and having competent support services available for those youth. Methods exist for helping youth with such a transition, but they are not currently widely available.

FFAs are expected to link their children/youth to needed Mental health services, but are those services available?

Since there are more children/youth in care who, due to having mild to moderate needs, are not in managed care than are in managed care. How will those needs be met? Can they be met with a fee-for-service structure? Who would determine reasonable costs? How can an FFA know that an agency/company offering fee-for-services is qualified to do so? At this point, there are more questions than answers.

CDSS has developed a CCR Implementation Guide and expect to put it out for general release in about two weeks. This guide is a tool to support FFAs in implementing CCR, but FFAs are not required to use it.

It was stated that it would be helpful for the State to create some guidelines for developing MOUs to support the need for increased capacity.

Sara Rogers did state that, regarding core services, an FFA must either provide, or have access to, each of the core services. She did state, however, that that the State is NOT requiring actual contracts for such services, but rather a working relationship (level of engagement) to ensure the children/youth have access to required services.

There are teams working on what is needed for an FFA to become “medi-cal certified.”

There was some discussion about the challenge of a child/youth needing a diagnosis in order to receive services and the fact that diagnosis can act as negative labeling. However, with the current structure, a diagnosis is needed in order to access services.

ACCREDITATION ADVICE:

A few weeks ago CCOFFA requested that FFAs send in advice about accreditation to those FFAs early in the process. Thanks so much for those willing to share with other FFAs.

We just submitted our application to CARF for the accreditation survey to take place in late August early September. We went to both the COA and CARF introduction seminars and decided to proceed with CARF. We put together an accreditation team within the organization consisting of social workers, administration and our bookkeeper (we are a small Agency with 14 employees, 10 Social Workers, 1 Foster Parent Coordinator, 1 Bookkeeper, 1 Administrator and 1 Program Director) As the Program Director I took the lead in the accreditation process but would not have been able to do it alone. We broke up the standards and worked on them individually noting what we are currently doing to meet the standard and what is needed to fully meet the standard. We met weekly and brought to the table what we had done while creating the list of what was needed. This took about 3 months to complete. Once what was needed was compiled we started to work on those needs as a group. We often broke the staff up into subcommittees to address the program material so that everyone was involved in the process. For full implementation of the standards it took us a little over a year. I would be happy to speak with you if you would like with any suggestions and/or questions that you or anyone else may have about how we proceeded with this.

Eric Mortensen, M.S. – Program Director

Kamali’i Foster Family Agency

We found COA to best meet our needs as we are mostly child welfare focused vs Mental Health. Some advice is to identity a Lead person in collaboration with the CEO to champion the accreditation process. Do kickoff and try to make it fun. There are designated number of standards and each manager or director should be assigned as the lead for the standard which is most relevant to them- i.e. HR, Ethics, governance, risk prevention and management, foster care, counseling, etc. Each standard lead can then enlist the help of certain “subject experts” i.e. foster care supervisor- to provide feedback and input on the multiple policies and procedures needed for each standard. There are many more steps in between …

Carol Ramirez, Lilliput

San Diego Center for Children and our foster agency Special Families Foster Care have been accredited through Joint Commission for 3 years now (May 2013) and just went through the re-accreditation last month. We were accredited through Joint Commission years ago and let that lapse because we were then doing accreditation through CA Alliance. We chose them because they had what we felt was the highest standards in the industry, the higher name recognition, and the fact that they accredit hospital facilities as well. Only advice I would give is that you really need to identify a point person who can dedicate a lot of time to this project, be ready to formally revise and create new policy and procedures, look to utilize outside consultants to help the process (we have done this both times and their feedback has been very helpful), and have plan to maintain standards. That being said, the accreditation organizations want us to get accredited (it’s in their best interest) and once it’s done you will be a better organization for it.

Stewart Holzman Program Manager, Special Families Foster Care/TFCO

We are going through CARF. The thing I am most pleased about is that we used a consulting agency to assist us. The firm is Powderhorn.

Mike Logan

Children First

I just submitted our application to CARF last Friday! We are scheduled for site visits in Oct/Nov. My advice would be to just make a decision and go for it. All have their pros and cons. I felt CARF was the most experienced in our field of social work of children, and that there wouldn’t be too much of a “square peg in a round hole.” From the time I received CARF’s information to application was 2 months for me. I just decided to hammer it out and it was long days and many weekends. This was my trick to CARF. I went through their handbook and made a spread sheet in excel of what I needed to do in all the different areas. I also put check boxes next to the items in their handbook of where the different information needed to go. I then took each item, which ranged from Board stuff, policy manuals, social worker manuals, foster parent manuals etc., and updated them with all the required information and check the items off as I went. The biggest decision we made was about our quality assurance and ETO measures. I had to create questionnaires and satisfaction surveys, but we decided to go with a data management system to gather all of this information. More of a quantitative route and not a qualitative route. A qualitative route would mean hiring an individual to monitor and provide oversight for quality assurance. A data management system will track all of our information in real time with feedback. I went with Social Solutions (Apricot system) after sitting in about 10 different data management pitch sales and demonstrations. They are well suited to meet the needs of any FFA/Adoptions/STRTC. They only work with nonprofits and understand our unique needs and their prices are reasonable. I want to do a big plug on them to all the COFFA FFAs later. The cost of a data management system is about 1/3 the cost of an employee. The other thing about CARF, which is not necessarily advertised is that they do not have monthly fees. Just the application fee and then the site visit fees, which are every 3 years.

CCOFFA’s request for advice and wisdom about the accreditation process also lead to a couple of companies contacting CCOFFA who help FFAs with accreditation. Their information is below. Sharing this information does not constitute an endorsement by CCOFFA, nor did CCOFFA receive any form of compensation for sharing this information:

Viable Solutions LLC (com) The following is from their website:

Viable Solutions has created materials that allow an organization to successfully and confidently pursue the time consuming task of national accreditation.

Viable Solutions has worked with approximately 195 agencies during the past several years assisting in meeting and implementing the standards of national accreditation through COA, CARF and the Joint Commission. The results for these agencies have been a 100% accreditation success rate. We are pleased to now offer our time tested, copy protected materials in an electronic format. In an effort to respond to the requests of organizations across the county, Viable Solutions will be offering a separate group of electronic services. Please call 1-888-378-6880 or 1-866-571-8312 to discuss how your accreditation needs can be met.

When an organization is searching for assistance with achieving national accreditation, it is imperative that they understand that a few policies and some suggestions as to how to create some of the other required areas will not meet the standard requirements of national accreditation. In order to meet the requirements for national accreditation, an organization needs to have the required materials in the areas of:

Policy and Procedures (Copywritten) (View Sample Document)

Corporate Compliance (Copywritten)

Health and Safety

Performance Management

Risk Management

Strategic Planning

Orientation and Training

Client Orientation

All Viable Solutions materials have been surveyed approximately 195 times and have successfully met all required standards. These copy protected materials are fully editable and can be adopted as is or can be adjusted to any degree necessary to meet your organizations internal needs. It is very important for an organization to understand what materials are needed and understand the standards well enough to recognize how the materials meet the required standards. Viable Solutions provides the most comprehensive and tested accreditation materials available.

So who are we and how can we help Foster & Adoption Agency’s in California with the accreditation process? 14 years ago Relias Learning set out to lead the world in online staff training and development, and we have done just that. Along the way we have developed a partnership with COA and established strong relationships with both CARF and The Joint Commission. Our relationship with each of these accrediting bodies is so strong that we have custom engineered Learning Crosswalks for each of them that align our courses of training with their high standards. As their standards change over time, so too does our content. The guarantee of updated/new content over the course of time assures that a very strong training platform can be built from the beginning with Relias. Add to that the over 600 hours of CEU’s that are in our database, at no added charge, and you can see why we have such a strong reputation across the country/world.

If you have any questions or concerns regarding RFA, you can email the state directly at rfa@dss.ca.gov

Or concerns regarding CCR at ccr@dss.ca.gov. Please remember, all the specifics regarding RFA and CCR are still being worked out.